Organization
SULLIVAN MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS GESLER MADHERE PHYSICIAN ASSISTANT (CEO)
(956) 485-1401
Entity
Organization
Contact information
Practice address
11325 W EXPRESSWAY 83, SULLIVAN, TX 78595
(956) 485-1401
(956) 485-0107
Mailing address
PO BOX 250, SULLIVAN CITY, TX 78595-0250
(956) 485-1401
(956) 485-1407
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
TX
207QA0505X
Adult Medicine Physician
—
TX
Other
Enumeration date
10/23/2006
Last updated
09/25/2007
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