Healthcare Provider Details

I. General information

NPI: 1477501476
Provider Name (Legal Business Name): CHRISTOPHER P SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST SUITE 301
AKRON OH
44304-1429
US

IV. Provider business mailing address

75 ARCH ST SUITE 301
AKRON OH
44304-1429
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-1899
  • Fax: 330-253-2108
Mailing address:
  • Phone: 330-253-1899
  • Fax: 330-253-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3544533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: