Individual
THOMAS SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1045 W STEPHENSON ST, FREEPORT, IL 61032-4864
(815) 599-6000
Mailing address
17503 BEAVERTON RD, CAPRON, IL 61012-9778
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-060631
IL
Other
Enumeration date
03/14/2006
Last updated
05/12/2008
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