Individual
KEVIN L SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7421 N MILWAUKEE AVE, NILES, IL 60714-3707
(773) 775-0811
(773) 819-7013
Mailing address
7421 N MILWAUKEE AVE, NILES, IL 60714-3707
(773) 993-0279
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036066244
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066244
—
IL
01
—
1602167
BCBS NUMBER
IL
Enumeration date
12/12/2006
Last updated
04/24/2023
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