Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 4301095988 | MI |
NPI | 1225262561 |
---|---|
Provider Name | Joseph P Sullivan |
First Address | Petoskey, MI 49770-8685 |
Second Address | Petoskey, MI 49770-8685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 09/08/2010 |