Provider Demographics
NPI:1609845700
Name:GILLICK, JOHN SCHILLER (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCHILLER
Last Name:GILLICK
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4069 ALAMEDA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1607
Mailing Address - Country:US
Mailing Address - Phone:610-692-3609
Mailing Address - Fax:619-692-2032
Practice Address - Street 1:1947 CABLE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2807
Practice Address - Country:US
Practice Address - Phone:619-223-1652
Practice Address - Fax:619-223-5443
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31808207LP2900X, 207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC31808BMedicare PIN
CAA34713Medicare UPIN