Individual
SEAN W SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 MEDICAL PARK DR, WATERVLIET, MI 49098-9225
(269) 463-3600
Mailing address
2000 GREEN RD, SUITE 300, ANN ARBOR, MI 48105-1598
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5101014473
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4714970
—
MI
05
—
4720636
—
MI
01
—
SS014473
BLUE CROSS BLUE SHIELD
MI
Enumeration date
05/31/2006
Last updated
07/09/2020
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