Provider Demographics
NPI:1801022967
Name:SULLIVAN, KATHLEEN CAMPBELL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:CAMPBELL
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Mailing Address - Street 2:3377 RIVERBEND DRIVE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-6389
Mailing Address - Fax:541-222-6385
Practice Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Practice Address - Street 2:3377 RIVERBEND DRIVE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6389
Practice Address - Fax:541-222-6385
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORLL18647207R00000X
CO51683207R00000X
ORMD158343208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500721348Medicaid
CO69008744Medicaid
CO023074OtherKAISER COMMERCIAL NUMBER