| Michelle L Sullivan Do Pc | |
|
1300 Copperfield Ave Suite 1020 Joliet IL 60432-2004 | |
| (877) 905-0336 | |
| (877) 905-0336 |
| Full Name | Michelle L Sullivan Do Pc |
|---|---|
| Speciality | General Practice |
| Location | 1300 Copperfield Ave, Joliet, Illinois |
| Authorized Official Name and Position | Michelle Sullivan (OWNER) |
| Authorized Official Contact | 8779050336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle L Sullivan Do Pc 1300 Copperfield Ave Suite 1020 Joliet IL 60432-2004 Ph: (877) 905-0336 | Michelle L Sullivan Do Pc 1300 Copperfield Ave Suite 1020 Joliet IL 60432-2004 Ph: (877) 905-0336 |
| NPI Number | 1891983417 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 02/05/2008 |
| Medicare PECOS PAC ID | 3678656105 |
|---|---|
| Medicare Enrollment ID | O20080207000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891983417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Illinois) | Primary |
| Provider Name | Michelle L Sullivan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659351070 PECOS PAC ID: 5698675858 Enrollment ID: I20040113000157 |
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