MEDICARE: PATRICK J SULLIVAN MDSC

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	207R00000X	Internal Medicine Physician	3639839	IL

General Provider Information

NPI Number	:	1649310327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK J SULLIVAN MDSC

Provider Business Mailing Address
First Line	:	150 EAST HURON STREET
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60611-2912
Country	:	US
Telephone Number	:	312-649-6565
Fax Number	:	312-649-9842

Provider Business Practice Location Address
First Line	:	150 EAST HURON STREET
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60611-2912
Country	:	US
Telephone Number	:	312-649-6565
Fax Number	:	312-649-9842

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PATRICK JOSEPH SULLIVAN
Credential	:
Telephone Number	:	312-649-6565

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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