Individual
ROBERT D SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1195 N CASALOMA DR, APPLETON, WI 54913-9295
(920) 734-0400
(920) 734-9054
Mailing address
1195 N CASALOMA DR, APPLETON, WI 54913-9295
(920) 734-0400
(920) 734-9054
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
18799
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30125300
—
WI
Enumeration date
10/06/2006
Last updated
02/19/2008
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