Provider Demographics
NPI:1649310327
Name:PATRICK J SULLIVAN MDSC
Entity type:Organization
Organization Name:PATRICK J SULLIVAN MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-649-6565
Mailing Address - Street 1:150 EAST HURON STREET
Mailing Address - Street 2:SUITE 805
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2912
Mailing Address - Country:US
Mailing Address - Phone:312-649-6565
Mailing Address - Fax:312-649-9842
Practice Address - Street 1:150 EAST HURON STREET
Practice Address - Street 2:SUITE 805
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2912
Practice Address - Country:US
Practice Address - Phone:312-649-6565
Practice Address - Fax:312-649-9842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3639839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12299Medicare UPIN
IL965020Medicare ID - Type Unspecified