Provider Demographics
NPI:1558345850
Name:SULLIVAN, DANIEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:E
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 1:7447 W TALCOTT AVENUE
Mailing Address - Street 2:SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-7898
Mailing Address - Fax:773-631-3005
Practice Address - Street 1:7447 W TALCOTT AVENUE
Practice Address - Street 2:SUITE 500 NORTHWEST ORTHOPAEDIC ASSOCIATES LTD
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-7898
Practice Address - Fax:773-631-3005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021604007OtherBSIL
IL0242720001OtherDME
IL0242720001OtherDME
ILL50239Medicare ID - Type Unspecified