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Individual

ELIZABETH MARIE SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3000
(317) 963-5492
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02007075A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
264430H20
MEDICARE PTAN
IN
05
300074260
IN
Enumeration date
04/01/2020
Last updated
09/04/2025
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