MEDICARE: DR. TORY SULLIVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	ME81131	FL
2	207N00000X	Dermatology Physician	ME81131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639137169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TORY SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	16100 NE 16TH AVE STE A
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4708
Country	:	US
Telephone Number	:	305-652-8600
Fax Number	:	305-652-3139

Provider Business Practice Location Address
First Line	:	16100 NE 16TH AVE STE A
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4708
Country	:	US
Telephone Number	:	305-652-8600
Fax Number	:	305-652-3139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/18/2025

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