Individual
DR. JEREMY TYSON SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10601 WINTERWOOD, CARMEL, IN 46032-8258
(615) 478-3720
Mailing address
10601 WINTERWOOD, CARMEL, IN 46032-8258
(615) 478-3720
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35131
TN
207R00000X
Internal Medicine Physician
Primary
01066525A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3865060
—
TN
Enumeration date
05/03/2006
Last updated
03/07/2023
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