Provider Demographics
NPI:1659356343
Name:CHILD, MONIQUE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:L
Last Name:CHILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-522-5437
Mailing Address - Fax:907-522-5435
Practice Address - Street 1:603 W TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-522-5437
Practice Address - Fax:907-522-5435
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108167208000000X
AK6196208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336069066OtherCTL SUBS LICENSE
IL036108167Medicaid
CO43083OtherCOLORADO STATE LICENSE
IL036108167OtherSTATE LICENSE
AK1020541Medicaid
ILBD9248558OtherDEA
IL036108167OtherSTATE LICENSE