Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 21301 | OK |
NPI | 1114918869 |
---|---|
Provider Name | Muhammad Monem Gillan |
First Address | Oklahoma City, OK 73103-2400 |
Second Address | Oklahoma City, OK 73103-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 04/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55688772 | (05) | NM |
H63575 | (02) |