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Individual
PAUL G SULLIVAN
Active
Individual
PAUL G SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070010530
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619908
BCBS IL GROUP NUMBER
IL
01
—
1623066
BCBS PROVIDER #
IL
01
—
367885100
US DEPT OF LABOR
IL
01
—
CJ4383
R.R. MEDICARE GRP#
IL
01
—
CJ8115
R.R. MEDICARE GRP#
IL
Enumeration date
09/17/2006
Last updated
05/11/2018
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