Individual
RYAN SEAN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-3964
(517) 205-7050
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02006712A
IN
390200000X
Student in an Organized Health Care Education/Training Program
510102407
MI
Other
Enumeration date
06/07/2018
Last updated
10/17/2022
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