Provider Demographics
NPI:1316943863
Name:SULLIVAN, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4510 MAIN ST
Mailing Address - Street 2:FL 2
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3800
Mailing Address - Country:US
Mailing Address - Phone:716-839-3057
Mailing Address - Fax:716-839-1477
Practice Address - Street 1:4510 MAIN ST
Practice Address - Street 2:FL 2
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3800
Practice Address - Country:US
Practice Address - Phone:716-839-3057
Practice Address - Fax:716-839-1477
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY206629207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5978Medicare ID - Type Unspecified
NYF52070Medicare UPIN