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General NPI Number Information
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NPI Number | 1477653897
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Entity Type | Organization
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Legal Business Name | DENNIS P. SULLIVAN, M.D., INC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 30 W. MCCREIGHT AVE STE 103
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City | SPRINGFIELD
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State | OH
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Zip | 45504
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Country | US
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Telephone | 937-399-8921
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Fax | 937-629-9248
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Provider Business Mailing Address
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Address Line | 30 W. MCCREIGHT AVE STE 103
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City | SPRINGFIELD
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State | OH
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Zip | 45504
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Country | US
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Telephone | 937-399-8921
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Fax | 937-629-9248
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DENNIS PATRICK SULLIVAN
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Credential | M.D.
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Telephone | 937-399-8921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35-037690
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License Number State | OH
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