MEDICARE: DR. LAURA 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	207R00000X	Internal Medicine Physician	G55298	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110227243	OTHER	CA	MEDICARE RAILROAD
5	110227243	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G552980	OTHER	CA	BLUE SHIELD
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	:	1700892437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	7316 S. SETTLER DR.
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465
Country	:	US
Telephone Number	:	714-722-4688
Fax Number	:	562-920-4642

Provider Business Practice Location Address
First Line	:	7316 S. SETTLER DR.
Second Line	:
City	:	MORRISON
State	:	CO
Zip	:	80465
Country	:	US
Telephone Number	:	714-722-4688
Fax Number	:	562-904-8095

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	11/26/2019

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Directions to “ DR. LAURA SULLIVAN M.D.” Practice Location

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