Individual
MICHAEL A SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 939-7725
Mailing address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 939-7725
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187611201
—
TX
01
—
8X7926
BCBS
TX
Enumeration date
05/25/2006
Last updated
10/27/2022
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