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NPI Code Detail

MEDICARE: RYAN A SULLIVAN MD

MEDICARE: RYAN A 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
1207R00000XInternal Medicine Physician430308010MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00267590OTHERMIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31105115182OTHERMIBCBS

General Provider Information

NPI Number : 1174605653
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN A SULLIVAN MD
Provider Business Mailing Address
First Line : 6227 FRANKFORT HWY
Second Line :
City : BENZONIA
State : MI
Zip : 49616-8632
Country : US
Telephone Number : 231-882-9661
Fax Number : 231-882-9616
Provider Business Practice Location Address
First Line : 2198 US HIGHWAY 31 S
Second Line :
City : MANISTEE
State : MI
Zip : 49660-9618
Country : US
Telephone Number : 231-723-3567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 12/30/2020

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Directions to “ RYAN A SULLIVAN MD” Practice Location

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