MEDICARE: DR. JOHN MICHAEL SULLIVAN MD

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	1922685916	IL
2	207P00000X	Emergency Medicine Physician	81236	CT
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922685916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL SULLIVAN MD

Provider Business Mailing Address
First Line	:	251 E HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-926-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 E HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:	312-926-2000
Fax Number	:

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

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	02/04/2026

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