Michael D Sullivan, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00024 Issued in TX

Practice address

705 Main St
Coppell, TX 75019-4742

Phone

(972) 304-6400

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 15, 2024 through Oct 15, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Harris 4 Health, PLLC

  • Family Nurse Practitioner
  • Coppell, TX
  • NPI 1326386004
  NPD (past)
• Lifestream Health Center PA

  • Specialist
  • Coppell, TX
  • NPI 1235363409
  NPD (past)
• Physicians and Allied Health Professionals Group, PA

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1528011814
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1689707515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 MAIN ST",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194742",
            "telephone_number": "972-304-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 MAIN ST",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750194742",
            "telephone_number": "972-304-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srividhya Subramanian
• Tina Marie Sugden, R.D.H.
• Suitable Homehealth Care Inc
• Woojung Sul, DMD
• Nawal Joulani Suleman, PA-C
• Shanielle Brianne Henslee Sum, MS, CCC-SLP
• Punam Sureka Rungta, DMD
• Anu Sury, D.O.
• Steven A. Swaldi, MD
• Omaimah Syed

• Physician Assistant in Coppell, TX
• Providers in Coppell, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.