Provider Demographics
NPI:1184683385
Name:SULLIVAN, DENNIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name: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 1:9315 N VALLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:RIVER HILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1036
Mailing Address - Country:US
Mailing Address - Phone:414-351-6392
Mailing Address - Fax:414-276-1758
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1330
Practice Address - Country:US
Practice Address - Phone:414-276-6000
Practice Address - Fax:414-276-1758
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19396207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI303000600Medicaid
WI0758920001Medicare NSC
WI000202672Medicare PIN
WI303000600Medicaid
WI000246190Medicare PIN