# MICHAEL W. SULLIVAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1275576944
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 20770 | NE | — |
| 207V00000X | Obstetrics & Gynecology Physician | 37645020 | WI | — |
| 208D00000X | General Practice Physician | 30828 | KY | Yes |

## Other

- **Enumeration date:** 06/13/2006
- **Last updated:** 06/24/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 47600743612 | — | NE |
| 05 | — | 47600743621 | — | NE |
| 05 | — | 47600743622 | — | NE |
| 05 | — | 47600743623 | — | NE |