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Organization
RYAN A SULLIVAN, MD PC
Active
Organization
RYAN A SULLIVAN, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN A SULLIVAN MD (OWNER)
(231) 398-1850
Entity
Organization
Contact information
Practice address
1391 E PARKDALE AVE, MANISTEE, MI 49660-9352
(231) 398-1850
Mailing address
1391 E PARKDALE AVE, MANISTEE, MI 49660-9352
(231) 398-1850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0511518
BCBS
MI
01
—
DE0302
RAILROAD MEDICARE
MI
01
—
P00267590
RAILROAD MEDICARE
MI
Enumeration date
10/06/2006
Last updated
04/10/2008
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