Organization
DENNIS P. SULLIVAN, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS PATRICK SULLIVAN M.D. (PHYSICIAN)
(937) 399-8921
Entity
Organization
Contact information
Practice address
30 W. MCCREIGHT AVE STE 103, SPRINGFIELD, OH 45504
(937) 399-8921
(937) 629-9248
Mailing address
30 W. MCCREIGHT AVE STE 103, SPRINGFIELD, OH 45504
(937) 399-8921
(937) 629-9248
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35-037690
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2945273
—
OH
01
—
SU4262411
MEDICARE PTAN
OH
Enumeration date
09/25/2006
Last updated
02/01/2010
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