Provider Demographics
NPI:1588959548
Name:NEVILLE, PATRICK MICHAEL SULLIVAN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL SULLIVAN
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4600 MEMORIAL DR STE 120
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5359
Mailing Address - Country:US
Mailing Address - Phone:618-222-1020
Mailing Address - Fax:618-222-1039
Practice Address - Street 1:4600 MEMORIAL DR STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5359
Practice Address - Country:US
Practice Address - Phone:618-222-1020
Practice Address - Fax:618-222-1039
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2021-02-22
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Provider Licenses
StateLicense IDTaxonomies
OH57.0172782086S0129X
IL0361334742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery