Individual
KYLE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8300 W 38TH AVE, WHEAT RIDGE, CO 80033-6005
(303) 422-9438
Mailing address
PO BOX 668, ARVADA, CO 80001-0668
(303) 422-9438
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
DR.0073410
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2019
Last updated
06/05/2024
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