Individual
MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1330 COSHOCTON AVE, MOUNT VERNON, OH 43050-1440
(740) 393-9000
(740) 392-0167
Mailing address
1330 COSHOCTON AVE, MOUNT VERNON, OH 43050-1440
(740) 393-9000
(740) 392-0167
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
35-071450
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000019555
ANTHEM
OH
05
—
0368516
—
OH
01
—
1342112
FIRST HEALTH
OH
Enumeration date
07/18/2005
Last updated
03/09/2021
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