MEDICARE: DR. MONICA M O'SULLIVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	44298	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	004000261V	OTHER	HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043262546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONICA M O'SULLIVAN MD

Provider Business Mailing Address
First Line	:	11211 W LINCOLN AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1035
Country	:	US
Telephone Number	:	414-454-8300
Fax Number	:	414-327-1450

Provider Business Practice Location Address
First Line	:	11211 W LINCOLN AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-1035
Country	:	US
Telephone Number	:	414-454-8300
Fax Number	:	414-327-1450

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/09/2021

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