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Contact Information

MICHAEL P SULLIVAN, MD
2101 SOUTH AVE
SOUTH LAKE TAHOE, CA96150
 Phone: 530-542-5744
 Fax: 530-542-5747
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurology

2084N0400X 13 Physician/Neurology
Indicates primary specialty

NPI Profile & details for MICHAEL P SULLIVAN · (Male)

NPI # 1336105626
Status Active
Credentials MD
Entity Individual
Enumeration date 04/25/2006
Last updated 09/28/2012 - About 14 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # G40941
  • NV License # 6833
  • CA Medicaid 00G409410
Hospital affiliation(s)
  • BARTON MEMORIAL HOSPITAL - (Acute Care)
    2170 SOUTH AVENUE
    SOUTH LAKE TAHOE, CA 96150
  • CARSON TAHOE REGIONAL MEDICAL CENTER - (Acute Care)
    1600 MEDICAL PARKWAY
    CARSON CITY, NV 89703
  • CARSON VALLEY MEDICAL CENTER - (Critical Access)
    1107 HIGHWAY 395
    GARDNERVILLE, NV 89410
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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