Provider Demographics
NPI:1003802166
Name:SULMAN, CECILLE G (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILLE
Middle Name:G
Last Name:SULMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF PEDIATRIC OTOLARYNGOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6467
Mailing Address - Fax:414-266-2693
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF PEDIATRIC OTOLARYNGOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6467
Practice Address - Fax:414-266-2693
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-110180207Y00000X
WI49373207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-110180Medicaid
WI1003802166Medicaid
WI009U73601Medicare PIN
WI1003802166Medicaid