Colleen Michelle Sullivan, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4301109875 Issued in MI

Practice address

5838 Metro Way SW
Wyoming, MI 49519-9619

Phone

(616) 249-5300

NPI assigned

Jun 7, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Battle Creek Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Wyoming, MI
  • NPI 1881642858
  NPD

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1265794010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 METRO WAY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199619",
            "telephone_number": "616-249-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "COLLEEN",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-07",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301109875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265794010",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Phillip Stull, DO
• Vivian Elise Stutzman, LLMSW
• Marcia Suazo
• Rebecca J Suggitt, LMSW
• Heidi Elizabeth Cronkright Suidinski, DO
• Maia Elise Sullivan, DO
• Michael James Sumners, D.O.
• Sunforest Family Medicine, PLC
• Diane Sutton
• Lydia Sutton, NP

• Physical Medicine & Rehabilitation Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.