Individual
DR. GERALD EDWARD SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6040 W LISBON AVE, SUITE 200, MILWAUKEE, WI 53210-2116
(414) 447-9890
(414) 447-9891
Mailing address
1169 N 13TH AVE, WEST BEND, WI 53090-1701
(262) 306-1997
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37202
WI
207RA0401X
Addiction Medicine (Internal Medicine) Physician
37202
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32475500
—
WI
Enumeration date
05/30/2007
Last updated
08/12/2019
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