Organization Name: | MICHELLE L SULLIVAN DO PC |
NPI Number: | 1891983417 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHELLE SULLIVAN (OWNER) |
Mailing Address: | 1300 Copperfield Ave Suite 1020 Joliet |
State: | IL US |
Postal Code: | 604322004 |
Phone Number: | 8779050336 |
Fax Number: | 8779050336 |
NPI Enumeration Date: | 10/09/2007 |
NPI Last Update Date: | 02/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |