Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301062393 | MI |
N | 2084N0400X | Neurologist | 4301062393 | MI |
NPI | 1033158530 |
---|---|
Provider Name | Dr. Stephen Sullivan |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 23/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H30071 | (02) | MI |