Individual
BONNIE RAE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(501) 951-2775
Mailing address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
2019020168
MO
208000000X
Pediatrics Physician
2019020168
MO
Other
Enumeration date
04/28/2015
Last updated
10/08/2019
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