MEDICARE: DR. JOHN ALEXANDER GILLEAN M.D.

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	2084P0800X	Psychiatry Physician	DR.0054348	CO
2	2084P0800X	Psychiatry Physician	A141657	CA

General Provider Information

NPI Number	:	1528378460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALEXANDER GILLEAN M.D.

Provider Business Mailing Address
First Line	:	55 SANTA CLARA AVE STE 171
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-541-2323
Fax Number	:	510-907-7966

Provider Business Practice Location Address
First Line	:	55 SANTA CLARA AVE STE 171
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-541-2323
Fax Number	:	510-907-7966

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	10/20/2021

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