Organization
THOMAS D. SULLIVAN, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS D SULLIVAN MD (PRESIDENT)
(630) 574-0934
Entity
Organization
Contact information
Practice address
120 N OAK ST, NEUROPHYSIOLOGY DEPARTMENT, HINSDALE, IL 60521-3829
(630) 574-0934
(630) 574-0934
Mailing address
PO BOX 3575, OAK BROOK, IL 60522-3575
(630) 574-0934
(630) 574-0934
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036-043333
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02201078
BLUE SHIELD
IL
05
—
036-043333
—
IL
Enumeration date
08/05/2006
Last updated
05/20/2008
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