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NPI Code Detail

MEDICARE: DR. MARION LOUISE SULLIVAN MD

MEDICARE: DR. MARION LOUISE 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
1207P00000XEmergency Medicine Physician17124AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0728670OTHERAZBCBS GROUP
24153051001OTHERAZGROUP HEALTH GROUP NUMBER
339-87220OTHERAZEVERCARE GROUP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5AW1936OTHERAZHEALTHNET GROUP

General Provider Information

NPI Number : 1962493692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARION LOUISE SULLIVAN MD
Provider Business Mailing Address
First Line : 9842 N 52ND ST
Second Line :
City : PARADISE VALLEY
State : AZ
Zip : 85253-1018
Country : US
Telephone Number : 480-348-1678
Fax Number :
Provider Business Practice Location Address
First Line : 2000 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-2443
Country : US
Telephone Number : 602-299-0212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 11/13/2007

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