Individual
THOMAS D SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 N. OAK STREET, HINSDALE, IL 60521
(630) 856-3901
(630) 856-3906
Mailing address
PO BOX 3575, OAK BROOK, IL 60522-3575
(630) 574-0934
(630) 574-2004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36-2924227
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02201078
BLUE SHIELD
IL
05
—
036-043333
—
IL
Enumeration date
07/05/2006
Last updated
03/22/2017
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