Lisa Sullivan, MD S.C.

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

Legal business name

LISA SULLIVAN, MD S.C.

Practice address

737 Saint Johns Ave
Highland Park, IL 60035-4650

Phone

(847) 805-8088

Fax

(847) 805-8088

NPI assigned

Jul 16, 2008

Organization subpart

No

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

Authorized official

Name

Lisa Marie SullivanNPI 1386650273

Title

President

Phone

(847) 805-8088

Specialties & licenses 2

Addresses

Other names 1

• PANACEA Allergy, Asthma & Immunology Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Marie Sullivan, M.D.

  • Allergy & Immunology Physician
  • Highland Park, IL
  • NPI 1386650273
  Medicare reassignment NPD Authorized official
• Hafsa Siddiqui, PA-C

  • Physician Assistant
  • Highland Park, IL
  • NPI 1295518231
  Medicare reassignment

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1790949980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19818 CYPRESS BRIDGE DR",
            "city": "ODESSA",
            "state": "FL",
            "postal_code": "335564399",
            "telephone_number": "847-805-8088",
            "fax_number": "847-805-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 SAINT JOHNS AVE",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600354650",
            "telephone_number": "847-805-8088",
            "fax_number": "847-805-8088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19818 Cypress Bridge Dr",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "FL",
            "postal_code": "335564399",
            "country_code": "US",
            "telephone_number": "847-805-8088 x101",
            "fax_number": "847-805-8844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LISA SULLIVAN, MD S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-16",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-805-8088"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "036107599",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PANACEA Allergy, Asthma & Immunology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Allergy & Immunology Physician in Highland Park, IL
• Providers in Highland Park, IL by specialty
• Allergy & Immunology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.