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Individual

DR. JOHN A GILLEN II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
900 MAIN ST, GRANDVIEW, MO 64030-2477
(816) 331-6700
(816) 876-2399
Mailing address
900 MAIN ST, GRANDVIEW, MO 64030-2477
(816) 331-6700
(816) 876-2399

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
110898
MO
207X00000X
Orthopaedic Surgery Physician
30353
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
17519026
BCBS GROUP #
MO
05
208537613
MO
05
208537621
KS
05
208537639
MO
01
23296023
BCBS INDIVIDUAL #
MO
01
607374400
DEPT OF LABOR
MO
Enumeration date
06/01/2005
Last updated
02/27/2012
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