Individual
DR. MICHAEL J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2510 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71118-3119
(504) 834-2062
Mailing address
PO BOX 8608, METAIRIE, LA 70011-8608
(504) 834-2062
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
017603
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1967432
—
LA
Enumeration date
03/20/2007
Last updated
07/08/2007
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