Individual
MICHAEL E SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
127 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 261-8500
Mailing address
127 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 261-8500
(920) 261-8828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46656
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34560600
—
WI
Enumeration date
11/30/2006
Last updated
04/07/2022
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