Individual
KENNETH SULLIVAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-5525
Mailing address
225 MEMORIAL DR, BERLIN, WI 54923-1243
(920) 361-1313
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
40493-020
WI
207Q00000X
Family Medicine Physician
Primary
40493-020
WI
208600000X
Surgery Physician
40493-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32483800
—
WI
Enumeration date
08/24/2005
Last updated
09/11/2025
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