| Doctor Name: | DR. GARRETT GRAY SULLIVAN |
| NPI Number: | 1740300094 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 04-33297 |
| Business Practice Address: | 2800 W 51st St Westwood, KS - 662051747 |
| Business Phone Number: | 9136260254 |
| Business Fax Number: | 9136249601 |
| Mailing Address: | 2800 W 51st St, WESTWOOD |
| State: | KS |
| Postal Code: | 662051747 |
| Phone Number: | 9136260254 |
| Fax Number: | 9136249601 |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 04-33297 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |