MEDICARE: KIMBERLY ANNE SULLIVAN L.AC.

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	171100000X	Acupuncturist		IL

General Provider Information

NPI Number	:	1356533038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE SULLIVAN L.AC.

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST STE 823
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6185
Country	:	US
Telephone Number	:	773-573-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 823
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6185
Country	:	US
Telephone Number	:	773-573-2828
Fax Number	:

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

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/15/2007

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Directions to “ KIMBERLY ANNE SULLIVAN L.AC.” Practice Location

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