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General NPI Number Information
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NPI Number | 1538154141
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Entity Type | Individual
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Provider Name | JAMES LEAHY SULLIVAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 680 E FREMONT MEDICAL PARK DR
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City | FREMONT
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State | NE
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Zip | 68025-2309
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Country | US
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Telephone | 402-727-1091
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Fax | 402-727-7628
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Provider Business Mailing Address
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Address Line | 19321 SPYGLASS CT
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City | PLATTSMOUTH
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State | NE
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Zip | 68048-7153
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Country | US
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Telephone | 402-296-2868
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23377
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License Number State | NE
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