Individual
DR. MICHAEL JUDE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2204 PAVILION DR STE 108, KINGSPORT, TN 37660-4651
(423) 392-6100
(423) 392-0803
Mailing address
2204 PAVILION DR STE 108, KINGSPORT, TN 37660-4651
(423) 392-6100
(423) 392-6159
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
15419
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000035347
BLUECARE
TN
05
—
3006621
—
TN
Enumeration date
12/14/2005
Last updated
11/28/2023
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