Healthcare Provider Details

I. General information

NPI: 1578552089
Provider Name (Legal Business Name): STEVEN GARRETT SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 E ARAPAHOE RD SUITE B110
CENTENNIAL CO
80112-4028
US

IV. Provider business mailing address

PO BOX 3274
GREENWOOD VILLAGE CO
80155-3274
US

V. Phone/Fax

Practice location:
  • Phone: 720-870-7446
  • Fax: 720-870-7460
Mailing address:
  • Phone: 720-870-7446
  • Fax: 720-870-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number26715
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: