Individual
DR. LEO W SULLIVAN. II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-5879
(618) 257-6740
Mailing address
902 MONTEREY DR, O FALLON, IL 62269-2833
(618) 624-8701
(618) 624-8701
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036068595
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930008245
RAILROAD MEDICARE
—
Enumeration date
02/08/2007
Last updated
01/06/2016
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