Provider Demographics
NPI:1811008253
Name:SULLIVAN, CHRISTOPHER ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2424 N. WYATT DR., STE. 260
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8571
Mailing Address - Country:US
Mailing Address - Phone:520-545-0608
Mailing Address - Fax:520-795-0354
Practice Address - Street 1:2424 N WYATT DR STE 260
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6118
Practice Address - Country:US
Practice Address - Phone:520-392-7500
Practice Address - Fax:520-323-4350
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45765207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ684096Medicaid