Sullivan, Kenneth

Sullivan, Kenneth is an individual health care provider with primary practice located at 225 Memorial Dr , Berlin WI 54923-1243. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Sullivan, Kenneth can be contacted via phone (920) 361-5525.

Contact Information

Primary practice address
225 Memorial Dr Berlin WI 54923-1243
Phone: (920) 361-5525
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 40493-020 Wisconsin
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 40493-020 Wisconsin
Allopathic & Osteopathic Physicians / Surgery 208600000X 40493-020 Wisconsin

Profile Details

NPI number 1902899917
LBN Legal business name Sullivan, Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2005
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902899917 NPPES
Wisconsin MEDICAID 32483800

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