| Organization Name: | SULLIVAN MEDICAL SQUARE, INC |
| NPI Number: | 1033403282 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN MURRAY (OWNER) |
| Mailing Address: | 15 S Kedzie Ave Chicago |
| State: | IL US |
| Postal Code: | 606122705 |
| Phone Number: | 7736382651 |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2011 |
| NPI Last Update Date: | 08/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 03612661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |