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Individual

DR. RANDALL GENE SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
EMILE @ 42ND ST, OMAHA, NE 68198-5575
(402) 552-6007
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
17415
NE
2084P0800X
Psychiatry Physician
MD2018-0063
NM
2084P0800X
Psychiatry Physician
MD29920
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10025598700
NE
05
47066229013
NE
01
P00681749
RAILROAD MEDICARE
Enumeration date
07/13/2006
Last updated
10/14/2025
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