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Individual

PAMELA ANN SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1000 EDGEWATER POINTE, SUITE: 200, LAKE ST. LOUIS, MO 63367
(636) 561-8088
(636) 561-1405
Mailing address
1000 EDGEWATER POINTE, SUITE - 200, LAKE ST. LOUIS, MO 63367
(636) 561-8088
(636) 561-1405

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
106412
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
208094821
MO
Enumeration date
03/09/2006
Last updated
12/29/2015
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