Provider Demographics
NPI:1881810695
Name:TORY SULLIVAN MD PA
Entity type:Organization
Organization Name:TORY SULLIVAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-652-8600
Mailing Address - Street 1:16100 NE 16TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4708
Mailing Address - Country:US
Mailing Address - Phone:305-652-8600
Mailing Address - Fax:305-652-3139
Practice Address - Street 1:16100 NE 16TH AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4708
Practice Address - Country:US
Practice Address - Phone:305-652-8600
Practice Address - Fax:305-652-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8854Medicare PIN
FLH97402Medicare UPIN