Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 75730-20 | WI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 75730-20 | WI |
N | 207XS0106X | Orthopaedic Hand Surgeon | 75730-20 | WI |
NPI | 1629463872 |
---|---|
Provider Name | Dr. Connor William Sullivan |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2015 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1629463872 | (05) | WI |