Individual
WILLIAM J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
608 WILLARD, FRONTENAC, KS 66763-2120
(620) 231-8849
(620) 231-8847
Mailing address
PO BOX 1023, FRONTENAC, KS 66763-1023
(620) 231-8849
(620) 231-8847
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
05-25406
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100234810D
—
KS
01
—
103449
MEDICARE
KS
01
—
110994
MEDICARE
KS
01
—
189381
COVENTRY
KS
01
—
200213791
TRICARE
KS
01
—
DA9115
GRP RR MEDICARE
KS
01
—
P00077657
RR MEDICARE
KS
Enumeration date
10/13/2006
Last updated
08/06/2016
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