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General NPI Number Information
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NPI Number | 1689634370
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Entity Type | Individual
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Provider Name | JOHN O'SULLIVAN MBBS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 701 DELLWOOD ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1920
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Country | US
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Telephone | 763-689-7700
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Fax | 763-689-7941
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Provider Business Mailing Address
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Address Line | PO BOX 43 MR 10809
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-0043
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Country | US
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Telephone | 612-262-4813
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Fax | 612-262-4194
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35074
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 3657
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0693
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License Number State | SD
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