Individual
DR. MICHAEL J. SULLIVAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N COTNER BLVD, SUITE 208, LINCOLN, NE 68505-2343
(402) 464-5969
(402) 464-3657
Mailing address
600 N COTNER BLVD, SUITE 208, LINCOLN, NE 68505-2343
(402) 464-5969
(402) 464-3657
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17866
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47060801513
—
NE
Enumeration date
04/05/2006
Last updated
11/07/2012
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