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NPI Code Detail

MEDICARE: MAURA K SULLIVAN PA

MEDICARE: MAURA K SULLIVAN PA
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
1363AM0700XMedical Physician Assistant5601005124MI

General Provider Information

NPI Number : 1255526810
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAURA K SULLIVAN PA
Provider Business Mailing Address
First Line : 1535 GULL ROAD
Second Line : SUITE 105
City : KALAMAZOO
State : MI
Zip : 49048-1630
Country : US
Telephone Number : 269-385-9900
Fax Number : 269-385-2140
Provider Business Practice Location Address
First Line : 1535 GULL ROAD
Second Line : SUITE 105
City : KALAMAZOO
State : MI
Zip : 49048-1630
Country : US
Telephone Number : 269-385-9900
Fax Number : 269-385-2140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2007
Last Update Date : 05/18/2020

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Directions to “ MAURA K SULLIVAN PA” Practice Location

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