Organization
SULLIVAN MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD E SULLIVAN MD (SOLE MBR)
(414) 447-9890
Entity
Organization
Contact information
Practice address
6040 W LISBON AVE, SUITE 200, MILWAUKEE, WI 53210-2116
(414) 447-9890
(414) 447-9891
Mailing address
6040 W LISBON AVE, SUITE 200, MILWAUKEE, WI 53210-2116
(414) 447-9890
(414) 447-9891
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
10/07/2013
Last updated
10/07/2013
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