Healthcare Provider Details

I. General information

NPI: 1043249725
Provider Name (Legal Business Name): JAMES J SULLIVAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 5TH ST
GLADWIN MI
48624-1162
US

IV. Provider business mailing address

3061 CHRISTY WAY
SAGINAW MI
48603-2267
US

V. Phone/Fax

Practice location:
  • Phone: 517-426-4521
  • Fax:
Mailing address:
  • Phone: 989-791-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101004290
License Number StateMI

VIII. Authorized Official

Name: JAMES J SULLIVAN
Title or Position: OWNER
Credential: DO
Phone: 517-426-4521