Provider Demographics
NPI:1164496014
Name:FONTANEZ SULLIVAN, FELIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:
Last Name:FONTANEZ SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A40 CALLE 2
Mailing Address - Street 2:TINTILLO GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1636
Mailing Address - Country:US
Mailing Address - Phone:787-798-5500
Mailing Address - Fax:787-787-2101
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 701
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-798-5585
Practice Address - Fax:787-787-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7754207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080708Medicare ID - Type Unspecified
PRD-38355Medicare UPIN