Provider Demographics
NPI:1437112943
Name:SULLIVAN, KAREN DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DIANE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML2008
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7966
Mailing Address - Fax:513-636-7967
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML2008
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7966
Practice Address - Fax:513-636-7967
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.120898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics