Provider Demographics
NPI:1336132612
Name:SULLIVAN, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
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:P.O. BOX 5990, DEPT 20-6001
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5990
Mailing Address - Country:US
Mailing Address - Phone:630-785-9100
Mailing Address - Fax:630-785-9199
Practice Address - Street 1:1 TRANSAM PLAZA DR
Practice Address - Street 2:SUITE 360
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4822
Practice Address - Country:US
Practice Address - Phone:630-785-9100
Practice Address - Fax:630-785-9199
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42965020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34087900Medicaid
WI34087900Medicaid
WI0009Medicare ID - Type Unspecified