Individual
DR. JONATHON SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4201 SAINT ANTOINE ST, SUITE 3R, DETROIT, MI 48201-2153
(313) 745-3000
Mailing address
25066 SPRINGBROOK DR, FARMINGTON HILLS, MI 48336-1950
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301060244
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
4301060244
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103159455
—
MI
05
—
104783832
—
MI
01
—
JS060244
BC/BS OF MICHGIAN
MI
Enumeration date
07/21/2006
Last updated
06/17/2010
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