MEDICARE: DR. MICHAEL J GILEWSKI PHD

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	103TA0700X	Adult Development & Aging Psychologist	PSY 9194	CA
2	103TR0400X	Rehabilitation Psychologist	PSY 9194	CA
3	103G00000X	Clinical Neuropsychologist	PSY 9194	CA

General Provider Information

NPI Number	:	1811993389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J GILEWSKI PHD

Provider Business Mailing Address
First Line	:	11406 LOMA LINDA DR RM 105
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6220
Fax Number	:	909-558-6278

Provider Business Practice Location Address
First Line	:	11406 LOMA LINDA DR RM 105
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6220
Fax Number	:	909-558-6278

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2022

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