Provider Demographics
NPI:1376581470
Name:GICHINGA-MUGWE, MONICAH W (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICAH
Middle Name:W
Last Name:GICHINGA-MUGWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICAH
Other - Middle Name:W
Other - Last Name:GICHINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:329 TRANQUILITY LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3159
Mailing Address - Country:US
Mailing Address - Phone:214-518-9612
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-4265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21954207R00000X
TXP5630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI04969Medicare UPIN