Individual
LAURA ANN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5500 AUTO CLUB DR, DEARBORN, MI 48126-2779
(313) 425-4705
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-4806
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.143333
OH
208000000X
Pediatrics Physician
Primary
4301513782
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0292514
—
OH
Enumeration date
03/27/2018
Last updated
05/13/2025
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