Healthcare Provider Details

I. General information

NPI: 1922037548
Provider Name (Legal Business Name): MICHAEL PATRICK SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SPRING ST
FRIDAY HARBOR WA
98250-9782
US

IV. Provider business mailing address

PO BOX 5096
BELLINGHAM WA
98227-5096
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2141
  • Fax: 360-378-3655
Mailing address:
  • Phone: 360-378-2141
  • Fax: 360-378-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00033030
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: