NPIMap

Organization Active NPI

Mary Lynn Sullivan, M.D.P.C.

  • Clinic/Center
  • Oak Lawn, IL
National Provider Identifier
1104074806
Registry record updated Sep 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
036077688 Issued in IL
Legal business name
MARY LYNN SULLIVAN, M.D.P.C.
Practice address
5660 W 95TH St
Suite 5
Oak Lawn, IL 60453-2380
Phone
(708) 499-4190
Fax
(708) 857-4427
NPI assigned
Sep 5, 2008
Last updated
Sep 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary Lynn Sullivan, MDNPI 1437168416
Title
President
Phone
(708) 499-4190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 036077688 IL Primary

Addresses

Primary practice location

5660 W 95TH St
Suite 5
Oak Lawn, IL 60453-2380

Mailing address

5660 W 95TH St
Suite 5
Oak Lawn, IL 60453-2380
Phone (708) 499-4190

National Provider Directory

National Provider Directory

Locations

5660 W 95th St
Ste 5
Oak Lawn, IL 60453
Phone (708) 499-4190

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220572800000",
    "number": "1104074806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5660 W 95TH ST",
            "address_2": "SUITE 5",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532380",
            "telephone_number": "708-499-4190",
            "fax_number": "708-857-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5660 W 95TH ST",
            "address_2": "SUITE 5",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532380",
            "telephone_number": "708-499-4190",
            "fax_number": "708-857-4427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LYNN SULLIVAN, M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-09-05",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-499-4190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036077688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.