Provider Demographics
NPI:1811258114
Name:SULLIVAN, RACHEL MAUPIN (DO)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MAUPIN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:CARTIER
Other - Last Name:MAUPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4400 BROADWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-753-6552
Mailing Address - Fax:
Practice Address - Street 1:4400 BROADWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-753-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8505207Q00000X
MO2015026164207Q00000X
KS05-38365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine