Provider Demographics
NPI:1558324889
Name:SULLIVAN, LAWRENCE GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GUY
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 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10240 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5425
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115220207XS0106X
CO49536207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO012664OtherKAISER COMMERCIAL NUMBER
IL036-115220Medicaid
CO52555321Medicaid
ILP000370961OtherMEDICARE RAILROAD
CO52555321Medicaid
ILP000370961OtherMEDICARE RAILROAD
CO012664OtherKAISER COMMERCIAL NUMBER
ILK31738Medicare PIN
IL036-115220Medicaid