MEDICARE: DR. CHRISTOPHER J. SULLIVAN MD

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	207RC0000X	Cardiovascular Disease Physician	036093913	IL

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	:	1770506271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J. SULLIVAN MD

Provider Business Mailing Address
First Line	:	17850 KEDZIE AVE STE 3250
Second Line	:
City	:	HAZEL CREST
State	:	IL
Zip	:	60429-2082
Country	:	US
Telephone Number	:	708-779-8700
Fax Number	:	708-957-1830

Provider Business Practice Location Address
First Line	:	17850 KEDZIE AVE STE 3250
Second Line	:
City	:	HAZEL CREST
State	:	IL
Zip	:	60429-2082
Country	:	US
Telephone Number	:	708-779-8700
Fax Number	:	708-957-1830

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/20/2021

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