Individual
MICHAEL PATRICK SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 SOUTH AVE, SO LAKE TAHOE, CA 96150
(530) 542-5744
(530) 542-5747
Mailing address
2101 SOUTH AVE, SO LAKE TAHOE, CA 96150
(530) 542-5744
(530) 542-5747
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
6833
NV
2084N0400X
Neurology Physician
Primary
G40941
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G409410
—
CA
Enumeration date
04/25/2006
Last updated
09/28/2012
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