MEDICARE: DR. BRIAN C SULLIVAN M.D.

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	207P00000X	Emergency Medicine Physician		IL

General Provider Information

NPI Number	:	1609874650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN C SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	9944 S ROBERTS RD
Second Line	:	SUITE 204
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1555
Country	:	US
Telephone Number	:	708-233-8709
Fax Number	:

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1256
Country	:	US
Telephone Number	:	708-923-5800
Fax Number	:	708-923-8324

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/16/2007

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