MICHAEL PATRICK SULLIVAN (NPI# 1336105626) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336105626 |
| Entity Type | Individual |
| Full Name | MICHAEL PATRICK SULLIVAN |
| Credential | MD |
| Practice Address |
2101 South Ave So Lake Tahoe CA 96150 |
| Practice Telephone | 5305425744 |
| Practice Fax Number | 5305425747 |
| Mailing Telephone | 5305425744 |
| Mailing Fax Number | 5305425747 |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2012-09-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
6833 | NV | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
G40941 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G409410 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366918617 | Michael David Sullivan | Social Worker | 403 1/2 Hector St, Ithaca, NY 14850-2025 | 2018-10-15 |
| 1376923292 | Michael Sullivan | Student in an Organized Health Care Education/Training Program | Walter Reed 8901 Rockville Pike, Bethesda, MD 20889-0001 | 2015-06-05 |
| 1881074896 | Michael Gregory Sullivan | Intermediate Care Facility, Mentally Retarded | 30 Hobomack Rd, Quincy, MA 02169-2508 | 2015-06-04 |
| 1104215136 | Michael Sullivan | Perfusionist | 137 Founders Way Ct, Cape Girardeau, MO 63701-9442 | 2015-01-14 |
| 1689927915 | Michael Robert Sullivan | Pharmacist | 41 Buena Vista St, Stamford, CT 06907-2402 | 2012-10-24 |
| 1154672038 | Michael James Sullivan | Dentist | 1882 Hard Rd, Columbus, OH 43235-1996 | 2012-10-02 |
| 1063791747 | Michael Gruer Sullivan | Counselor | 2024 N. Crystal Lake Dr., Suite 200 Room 205, Lakeland, FL 33801-6015 | 2011-08-11 |
| 1457647083 | Michael Patrick Sullivan | Dentist | 1008 G Sreet, Geneva, NE 68361 | 2011-06-22 |
| 1841528585 | Michael Andrew Sullivan | Counselor | 974 73rd St Ste 9, Windsor Heights, IA 50324-1026 | 2009-11-18 |
| 1508191388 | Michael Joseph Sullivan | Audiologist | 6644 Penn Ave S, Richfield, MN 55423-2026 | 2009-10-12 |
| Street Address |
2101 SOUTH AVE |
| City | SO LAKE TAHOE |
| State | CA |
| Zip Code | 96150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750818969 | Terri Wong | Behavior Technician | 908 Alameda Ave, #b, South Lake Tahoe, CA 96150 | 2017-05-18 |
| 1154735157 | Catherine Anne Jones | Dental Hygienist | 1088 4th St # 6, South Lake Tahoe, CA 96150 | 2014-06-17 |
| 1245663194 | Sheila Marie Gwin | Behavioral Analyst | 2111south Ave, South Lake Tahoe, CA 96150 | 2013-08-14 |
| 1164785598 | Launa Jean Martin | Doula | 1399 Bozeman Dr, South Lake Tahoe, CA 96150 | 2012-06-20 |
| 1881957355 | Elizabeth Marilyn Mcnamara | Emergency Medicine | Barton Memorial Hospital, 2107 South Ave, South Lake Tahoe, CA 96150 | 2012-06-20 |
| 1295034627 | Dana Elizabeth Cox | Chiropractor | 3097 Harrison Ave., # 202, S. Lake Tahoe, CA 96150 | 2011-03-24 |
| 1639485162 | April Lyn Westfall | Dentist | 3358 Sandy Way, # B, S Lake Tahoe, CA 96150 | 2010-08-21 |
| 1700199270 | Rollie E Rohnow | Pharmacist | 1020 Al Tahoe Blvd, Rite Aid Pharmacy, South Lake Tahoe, CA 96150 | 2010-07-26 |
| 1699000455 | Ellen Newell Mccullough | Physical Therapist | 1900 High Meadow Trail, South Lake Tahoe, CA 96150 | 2009-10-13 |
| 1093941148 | Ashley Elizabeth Bedell | Counselor | 1137 Emerald Bay Rd., South Lake Tahoe, CA 96150 | 2009-06-03 |
| Find all providers in zip 96150 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
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| 1497352876 | Riverside Optimal Healthcare, Inc | Psychiatry & Neurology | 13320 Riverside Dr Ste 204, Sherman Oaks, CA 91423-2512 | 2020-10-08 |
| 1710592431 | Muhammad Amin | Psychiatry & Neurology | 33433 Pony Loop, Fremont, CA 94555-3511 | 2020-09-10 |
| 1558973792 | Catalyst Neuromedical Center PC | Psychiatry & Neurology | 3305 Placer St Ste B, Redding, CA 96001-2378 | 2020-08-19 |
| 1134730906 | West Coast Valley Medical Inc | Psychiatry & Neurology | 3357 Cahuenga Blvd W # 18, Los Angeles, CA 90068-1327 | 2020-08-13 |
| 1720603582 | Lily Wenya Zhou | Psychiatry & Neurology | 780 Welch Road, Suite 350, Stanford Stroke Center, Palo Alto, CA 94304 | 2020-06-08 |
| 1760015689 | Simon James Little | Psychiatry & Neurology | 1634 Divisadero St, Suite 250, San Francisco, CA 94115 | 2020-02-19 |
| 1427689256 | Alejandro F Centurion Md Inc | Psychiatry & Neurology | 100 Clock Tower Pl Ste 225, Carmel, CA 93923-8778 | 2020-01-30 |
| 1659901254 | Kern County Neurological Medical Group, Inc | Psychiatry & Neurology | 18645 Gale Ave Ste 228b, City of Industry, CA 91748-1363 | 2020-01-22 |
| 1609415314 | Aspire Holdings, Inc | Psychiatry & Neurology | 28212 Kelly Johnson Pkwy Ste 215, Valencia, CA 91355-5090 | 2019-12-27 |
| 1336785187 | Tp-health Ca PC | Psychiatry & Neurology | 201 E Center St Ste 112, Anaheim, CA 92805-7212 | 2019-11-26 |
| Find all providers with the same taxonomy | ||||
| City | SO LAKE TAHOE |
| Zip Code | 96150 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.