Individual
DENNIS MICHAEL SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 COMANCHE TRL, WEST MONROE, LA 71291-8117
(318) 396-4828
Mailing address
703 COMANCHE TRL, WEST MONROE, LA 71291-8117
(318) 396-4828
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
017356
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1941549
—
LA
Enumeration date
06/30/2006
Last updated
07/08/2007
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