Individual
DR. RENEE MARIE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
ONE HOSPITAL DRIVE, COLUMBIA, MO 65201-0001
(573) 882-2296
(573) 884-7743
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
37329
IA
207R00000X
Internal Medicine Physician
R-7363
IA
207RC0000X
Cardiovascular Disease Physician
Primary
2012016543
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70404
WELLMARK BCBS
IA
Enumeration date
05/14/2007
Last updated
07/06/2012
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