Provider Demographics
NPI:1750362000
Name:SULLIVAN, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
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 1:75 BARCLAY CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4508
Mailing Address - Country:US
Mailing Address - Phone:248-853-9177
Mailing Address - Fax:248-853-7258
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:STE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4508
Practice Address - Country:US
Practice Address - Phone:248-853-9177
Practice Address - Fax:248-853-7258
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4386959-10Medicaid
MI438695910Medicaid
MI438695910Medicaid
H17103Medicare UPIN
N26700013Medicare ID - Type Unspecified