Organization
MIDWEST EMERGENCY ASSOCIATES DE PAUL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL SULLIVAN MD (PRESIDENT)
(630) 734-0200
Entity
Organization
Contact information
Practice address
12303 DEPAUL DR, BRIDGETON, MO 63044
(314) 344-6000
(630) 734-1560
Mailing address
PO BOX 5990, DEPT 20 6006, CAROL STREAM, IL 60197-5990
(630) 734-0200
(630) 734-1560
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506085505
—
MO
Enumeration date
05/31/2006
Last updated
02/08/2008
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