Provider Demographics
NPI:1437350030
Name:SULLIVAN, MARC D (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
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 1:16838 E PALISADES
Mailing Address - Street 2:SUITE C153
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268
Mailing Address - Country:US
Mailing Address - Phone:480-816-3131
Mailing Address - Fax:480-816-3136
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:SUITE C153
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3845
Practice Address - Country:US
Practice Address - Phone:480-816-3131
Practice Address - Fax:480-816-3136
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ40747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine