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General NPI Number Information
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NPI Number | 1083747992
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Entity Type | Individual
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Provider Name | JAMES M SULLIVAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 W 1ST ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2208
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Country | US
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Telephone | 812-333-4327
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Fax | 812-961-1521
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Provider Business Mailing Address
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Address Line | 1000 W 1ST ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2208
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Country | US
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Telephone | 812-333-4327
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Fax | 812-961-1521
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 09A102673
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License Number State | IN
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