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Individual

MICHAEL SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
137 FOUNDERS WAY CT, CAPE GIRARDEAU, MO 63701-9442
(573) 450-8189
Mailing address
137 FOUNDERS WAY CT, CAPE GIRARDEAU, MO 63701-9442
(573) 450-8189

Taxonomy

Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
20140118235
MO

Other

Enumeration date
01/14/2015
Last updated
01/14/2015
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