Sullivan, Michael A

Sullivan, Michael A is an individual health care provider with primary practice located at 3414 Golden Rd , Tyler TX 75701-8336. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Sullivan, Michael A can be contacted via phone (903) 939-7500.

Contact Information

Primary practice address
3414 Golden Rd Tyler TX 75701-8336
Phone: (903) 939-7500
Fax: (903) 939-7725
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X

Profile Details

NPI number 1568418242
LBN Legal business name Sullivan, Michael A
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Oct 27th, 2022 - about 2 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 1568418242 NPPES
Texas MEDICAID 187611201
Texas Other 8X7926

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