MEDICARE: TORY SULLIVAN MD 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
1	207N00000X	Dermatology Physician	ME81131	FL

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

General Provider Information

NPI Number	:	1881810695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TORY SULLIVAN MD PA

Provider Business Mailing Address
First Line	:	16100 NE 16TH AVE STE A
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4708
Country	:	US
Telephone Number	:	305-652-8600
Fax Number	:	305-652-3139

Provider Business Practice Location Address
First Line	:	16100 NE 16TH AVE STE A
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4708
Country	:	US
Telephone Number	:	305-652-8600
Fax Number	:	305-652-3139

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TORY SULLIVAN
Credential	:	MD
Telephone Number	:	305-652-8600

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	11/18/2009

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