Provider Demographics
NPI:1962547901
Name:O'SULLIVAN, MICHAEL BRENDAN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRENDAN
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2450 RIVERSIDE AVE # F273
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE # F273
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:612-273-8727
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN194052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry