Provider Demographics
NPI:1043262546
Name:O'SULLIVAN, MONICA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:M
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:M
Other - Last Name:ZIEBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11211 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1035
Mailing Address - Country:US
Mailing Address - Phone:414-454-8300
Mailing Address - Fax:414-327-1450
Practice Address - Street 1:11211 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1035
Practice Address - Country:US
Practice Address - Phone:414-454-8300
Practice Address - Fax:414-327-1450
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004000261VOtherHUMANA
WI1043262546Medicaid
WI34193700Medicaid
004000261VOtherHUMANA
WI1043262546Medicaid