Provider Demographics
NPI:1376049346
Name:SULLIVAN, PATRICK DANIEL (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DANIEL
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 1:2109 HUGHES DR STE 400
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3858
Mailing Address - Country:US
Mailing Address - Phone:419-291-2088
Mailing Address - Fax:194-796-0064
Practice Address - Street 1:2109 HUGHES DR STE 400
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5143
Practice Address - Country:US
Practice Address - Phone:419-291-2088
Practice Address - Fax:194-796-0064
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301510460207R00000X
OH35.141679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine