Individual
MICHAEL J SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4700 MEMORIAL DR STE 340, BELLEVILLE, IL 62226-5373
(618) 234-9884
Mailing address
4500 MEMORIAL DRIVE, MEMORIAL HOSPITAL MEDICAL AFFAIRS, BELLEVILLE, IL 62226
(618) 257-4644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/30/2014
Last updated
02/28/2021
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