Individual
DR. MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1700 1ST AVE NE, SUITE 210, CEDAR RAPIDS, IA 52402-5433
(319) 363-3543
Mailing address
1700 1ST AVE NE, CEDAR RAPIDS, IA 52402-5433
(319) 363-3543
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00832
IA
213ES0103X
Foot & Ankle Surgery Podiatrist
2003000653
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308753201
—
MO
Enumeration date
11/13/2006
Last updated
07/27/2010
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