Individual
THERESA E SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O. , M.P.H
Contact information
Practice address
13250 WASHINGTON AVE, MOUNT PLEASANT, WI 53177-1516
(262) 799-8700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 649-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125060039
IL
207R00000X
Internal Medicine Physician
62926
WI
208M00000X
Hospitalist Physician
Primary
62926
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032.0109679
STATE LICENSE
VT
05
—
100040719
—
WI
Enumeration date
08/05/2011
Last updated
10/16/2023
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