Provider Demographics
NPI:1649230756
Name:SULLIVAN, KATHLEEN THERESE (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SULLIVAN
Other - Last Name:SCHIAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:504-455-1072
Practice Address - Street 1:2700 NAPOLEON AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6914
Practice Address - Country:US
Practice Address - Phone:504-885-8563
Practice Address - Fax:504-455-1072
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024978207V00000X
LAMD.024978207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09373764Medicaid
LA1422622Medicaid
I15542Medicare UPIN
LA469656YH3UMedicare PIN
4J012Medicare ID - Type Unspecified