Individual
MICHAEL W. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 SPEARHEAD DIVISION AVE DEPT 140, FORT KNOX, KY 40122-5104
(502) 613-4605
(502) 613-4549
Mailing address
1600 SPEARHEAD DIVISION AVE DEPT 140, FORT KNOX, KY 40122-5104
(502) 613-4605
(502) 613-4549
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20770
NE
207V00000X
Obstetrics & Gynecology Physician
37645020
WI
208D00000X
General Practice Physician
Primary
30828
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47600743612
—
NE
05
—
47600743621
—
NE
05
—
47600743622
—
NE
05
—
47600743623
—
NE
Enumeration date
06/13/2006
Last updated
06/24/2014
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