Active NPI
Michael Sullivan
- Perfusionist
- Cape Girardeau, MO
National Provider Identifier
1104215136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 20140118235
- Practice address
- 137 Founders Way CT
Cape Girardeau, MO 63701-9442 - Phone
- (573) 450-8189
- NPI assigned
- Jan 14, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 20140118235 | MO | Primary |
Addresses
Primary practice location
137 Founders Way CT
Cape Girardeau, MO 63701-9442
Mailing address
137 Founders Way CT
Cape Girardeau, MO 63701-9442
Phone (573) 450-8189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20140118235 | MO | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421193600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421193600000",
"number": "1104215136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "137 FOUNDERS WAY CT",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637019442",
"telephone_number": "573-450-8189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 FOUNDERS WAY CT",
"city": "CAPE GIRARDEAU",
"state": "MO",
"postal_code": "637019442",
"telephone_number": "573-450-8189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-14",
"last_updated": "2015-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "MO",
"license": "20140118235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Girardeau, MO
- Carrie Ann Stroup, M.A. CCC-SLP
- Success Vision Express of Cape, LLC
- Success Vision Eyecare of Cape, LLC
- Ashley Sullivan, LMT MMP
- Elizabeth Marie Sullivan, LPC
- Susan G Sulser, APRN,MSN,BC,FNP
- Joseph Kadathalakunnel Sunny, M.D.
- Superior Medical Supplies, LLC
- Surgery Center of Cape Girardeau, LLC
- Deborah P Sutherland, NP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.