Sullivan, Michael Jude

Sullivan, Michael Jude is an individual health care provider with primary practice located at 2204 Pavilion Dr Ste 108 , Kingsport TN 37660-4651. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Sullivan, Michael Jude can be contacted via phone (423) 392-6100.

Contact Information

Primary practice address
2204 Pavilion Dr Ste 108 Kingsport TN 37660-4651
Phone: (423) 392-6100
Fax: (423) 392-0803
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 15419 Tennessee

Profile Details

NPI number 1326023078
LBN Legal business name Sullivan, Michael Jude
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 14th, 2005
Last updated Nov 28th, 2023 - 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 1326023078 NPPES
Tennessee MEDICAID 3006621
Tennessee Other 000035347

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