MEDICARE: DR. PATRICIA SUSANA SULLIVAN MD MPH

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	208D00000X	General Practice Physician	15987	SC
2	207Q00000X	Family Medicine Physician	40062	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	F427208066	OTHER		MEDICARE ID-TYPE UNSELECTED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2015987	OTHER	SC	CDS

General Provider Information

NPI Number	:	1861455222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA SUSANA SULLIVAN MD MPH

Provider Business Mailing Address
First Line	:	14251 N 6TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85022-4224
Country	:	US
Telephone Number	:	602-882-9486
Fax Number	:	480-269-9462

Provider Business Practice Location Address
First Line	:	702 E BELL RD
Second Line	:	STE 112
City	:	PHOENIX
State	:	AZ
Zip	:	85022-6639
Country	:	US
Telephone Number	:	602-826-7134
Fax Number	:	480-269-9462

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. PATRICIA SUSANA SULLIVAN MD MPH” Practice Location

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