Healthcare Provider Details

I. General information

NPI: 1902911027
Provider Name (Legal Business Name): WILLIAM P. SULLIVAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21200 S LA GRANGE RD # 365
FRANKFORT IL
60423-2003
US

IV. Provider business mailing address

21200 S LA GRANGE RD # 365
FRANKFORT IL
60423-2003
US

V. Phone/Fax

Practice location:
  • Phone: 877-778-5449
  • Fax: 877-778-5449
Mailing address:
  • Phone: 877-778-5449
  • Fax: 877-778-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02001489A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036088666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: