Provider Demographics
NPI:1437138278
Name:SULLIVAN, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1450 NW 6035
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-6035
Mailing Address - Country:US
Mailing Address - Phone:800-634-4064
Mailing Address - Fax:952-213-6880
Practice Address - Street 1:5775 WAYZATA BLVD.
Practice Address - Street 2:SUITE 190
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2627
Practice Address - Country:US
Practice Address - Phone:952-541-1840
Practice Address - Fax:952-513-6880
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN430642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN689492500Medicaid
MN689492500Medicaid
MNF82835Medicare UPIN
F82835Medicare UPIN