Individual
PHYLLIS L. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7405 RENNER RD, KU MEDWEST, SHAWNEE, KS 66217-9414
(913) 588-8400
(913) 588-8413
Mailing address
2330 SHAWNEE MISSION PKWY, MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312, WESTWOOD, KS 66205-2005
(913) 588-9000
(913) 588-9822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-24472
KS
207Q00000X
Family Medicine Physician
R1H49
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001636401
CHP PROVIDER NUMBER
—
05
—
100231070B
—
KS
01
—
13470888
BCBS
—
01
—
157695XX
PREFERRED CARE OF NY
—
01
—
25562039
BCBS KUMW UC
—
01
—
326972
FIRSTGUARD
—
01
—
4331498
AETNA
—
01
—
481159444
JAYHAWK TAX ID
—
01
—
P00052983
RR MEDICARE
—
Enumeration date
06/12/2006
Last updated
09/13/2011
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