Michelle L Sullivan DO PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MICHELLE L SULLIVAN DO PC

Practice address

1300 Copperfield Ave
Suite 1020
Joliet, IL 60432-2004

Phone

(877) 905-0336

Fax

(877) 905-0336

NPI assigned

Oct 9, 2007

Last updated

Feb 5, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michelle Sullivan, D.O.NPI 1659351070

Title

Owner

Phone

(877) 905-0336

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

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.

• Michelle L Sullivan, D.O.

  • Family Medicine Physician
  • Tinley Park, IL
  • NPI 1659351070
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202169600000",
    "number": "1891983417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 COPPERFIELD AVE",
            "address_2": "SUITE 1020",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604322004",
            "telephone_number": "877-905-0336",
            "fax_number": "877-905-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 COPPERFIELD AVE",
            "address_2": "SUITE 1020",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604322004",
            "telephone_number": "877-905-0336",
            "fax_number": "877-905-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELLE L SULLIVAN DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2008-02-05",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "877-905-0336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Joliet, IL
• Providers in Joliet, IL by specialty
• General Practice Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2008; 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.