Individual
JOSEPH R SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-6589
Mailing address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-6589
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101019532
MI
208600000X
Surgery Physician
Primary
65368-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100058377
—
WI
Enumeration date
07/01/2011
Last updated
02/06/2024
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