MEDICARE: DR. JOHN SCHILLER GILLICK MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	C31808	CA
2	207R00000X	Internal Medicine Physician	C31808	CA
3	2083X0100X	Occupational Medicine Physician	C31808	CA

General Provider Information

NPI Number	:	1609845700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SCHILLER GILLICK MD, MPH

Provider Business Mailing Address
First Line	:	4069 ALAMEDA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1607
Country	:	US
Telephone Number	:	610-692-3609
Fax Number	:	619-692-2032

Provider Business Practice Location Address
First Line	:	1947 CABLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-2807
Country	:	US
Telephone Number	:	619-223-1652
Fax Number	:	619-223-5443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/11/2025

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