Individual
JOHN B GILLEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
435 SOUTH BURNETT ROAD, SPRINGFIELD, OH 45505-2717
(937) 325-8796
(937) 325-3640
Mailing address
435 SOUTH BURNETT ROAD, SPRINGFIELD, OH 45505-2717
(937) 325-8796
(937) 325-3640
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35-06-4962-G
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000009482
ANTHEM PROVIDER NUMBER
OH
01
—
040006587
RAILROAD MEDICARE PROVIDE
OH
05
—
0931684
—
OH
01
—
1000182
UNITED HEALTH CARE PROVID
OH
01
—
4321313
AETNA PROVIDER NUMBER
OH
Enumeration date
02/01/2006
Last updated
02/22/2008
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