Provider Demographics
NPI:1073571584
Name:SULLIVAN, TERENCE P (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:P
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MICHIGAN AVE
Mailing Address - Street 2:STE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2404
Mailing Address - Country:US
Mailing Address - Phone:312-922-2500
Mailing Address - Fax:312-922-2523
Practice Address - Street 1:200 S MICHIGAN AVE
Practice Address - Street 2:STE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2404
Practice Address - Country:US
Practice Address - Phone:312-922-2500
Practice Address - Fax:312-922-2523
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634412OtherBCBS
IL036081148Medicaid
IL01634412OtherBCBS
K18011Medicare UPIN