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
Phone: (530) 542-5744
Fax: (530) 542-5747
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336105626 | NPPES |
| California | MEDICAID | 00G409410 |
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