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Individual
TIM SULLIVAN
Active
Individual
TIM SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
34411
IA
208000000X
Pediatrics Physician
Primary
C55917
CA
Other
Enumeration date
09/25/2006
Last updated
07/29/2019
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