Sullivan, Michael Patrick

Sullivan, Michael Patrick is an sole proprietor health care provider with primary practice located at 2101 South Ave , So Lake Tahoe CA 96150. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Sullivan, Michael Patrick can be contacted via phone (530) 542-5744.

Contact Information

Primary practice address
2101 South Ave So Lake Tahoe CA 96150
Fax: (530) 542-5747
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X G40941 California
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 6833 Nevada

Profile Details

NPI number 1336105626
LBN Legal business name Sullivan, Michael Patrick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 25th, 2006
Last updated Sep 28th, 2012 - about 13 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 1336105626 NPPES
California MEDICAID 00G409410

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