# SULLIVAN MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205263159
- **Authorized official:** GERALD E SULLIVAN MD (SOLE MBR)
- **Authorized official phone:** (414) 447-9890

## Contact information

- **Practice address:** 6040 W LISBON AVE, SUITE 200, MILWAUKEE, WI 53210-2116
- **Practice address phone:** (414) 447-9890
- **Practice address fax:** (414) 447-9891
- **Mailing address:** 6040 W LISBON AVE, SUITE 200, MILWAUKEE, WI 53210-2116
- **Mailing address phone:** (414) 447-9890
- **Mailing address fax:** (414) 447-9891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/07/2013
- **Last updated:** 10/07/2013