Individual
TYLER SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5808 COPPER BEECH BLVD APT C, KALAMAZOO, MI 49009-5717
(765) 661-8006
Mailing address
5808 COPPER BEECH BLVD APT C, KALAMAZOO, MI 49009-5717
(765) 661-8006
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002089A
IN
Other
Enumeration date
09/17/2014
Last updated
09/17/2014
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