Individual
DR. DENNIS JAMES SULLIVAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
72718 MAPLE STREET, ODANAH, WI 54861-0250
(715) 682-7133
(715) 685-7848
Mailing address
PO BOX 250, ODANAH, WI 54861-0250
(715) 682-7133
(715) 685-7848
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
42911
WI
208600000X
Surgery Physician
43063
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34021900
—
WI
Enumeration date
10/20/2006
Last updated
02/20/2008
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