MICHAEL A SULLIVAN (NPI# 1568418242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568418242 |
| Entity Type | Individual |
| Full Name | MICHAEL A SULLIVAN |
| Credential | PA |
| Practice Address |
3414 Golden Rd Tyler TX 75701-8336 |
| Practice Telephone | 9039397500 |
| Practice Fax Number | 9039397725 |
| Mailing Telephone | 9039397500 |
| Mailing Fax Number | 9039397725 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-04-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 187611201 | 05 | |
| TX | BCBS | 8X7926 | 01 |
| 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 |
3414 GOLDEN RD |
| City | TYLER |
| State | TX |
| Zip Code | 75701-8336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487640173 | James Robert Harris | Orthopaedic Surgery | 3414 Golden Rd, Tyler, TX 75701-8336 | 2005-09-27 |
| 1104433739 | Ortholonestar, Pllc | Orthopaedic Surgery | 3414 Golden Rd, Tyler, TX 75701-8336 | 2020-09-28 |
| 1912528498 | Brooke Nicole Mcdaniel | Occupational Therapy Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2020-05-06 |
| 1912526153 | Iana G Harris | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2020-04-08 |
| 1104450832 | Lindsey Michelle Markel | Nurse Practitioner | 3414 Golden Rd, Tyler, TX 75701-8336 | 2020-03-03 |
| 1568009058 | East Texas First Surgical Support Pllc | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2019-12-04 |
| 1770144701 | Olsv3 Pllc | Orthopaedic Surgery | 3414 Golden Rd, Tyler, TX 75701-8336 | 2019-06-20 |
| 1740840651 | Samantha Anderson Ray | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2019-06-13 |
| 1326540097 | Jennifer Marie Mckelva | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2018-03-08 |
| 1730601790 | Justin Alan Williams | Nurse Practitioner | 3414 Golden Rd, Tyler, TX 75701-8336 | 2017-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316114655 | Chanda Lea Nicosia | Physician Assistant | 13674 Arizona Dr, Tyler, TX 75707-6806 | 2008-05-15 |
| 1770571093 | Paul Blake Chlapek | Physician Assistant | 1905 S Donnybrook Ave, Tyler, TX 75701-4236 | 2005-10-11 |
| 1912526153 | Iana G Harris | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2020-04-08 |
| 1568009058 | East Texas First Surgical Support Pllc | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2019-12-04 |
| 1740840651 | Samantha Anderson Ray | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2019-06-13 |
| 1326540097 | Jennifer Marie Mckelva | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2018-03-08 |
| 1649309410 | Jonathan R Redwing | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2007-03-05 |
| 1972534683 | Marvin Dean Pennington | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2006-07-05 |
| 1639167703 | Robert Daniel Walker | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2005-10-12 |
| 1851389175 | Forrest Rice Persing | Physician Assistant | 3414 Golden Rd, Tyler, TX 75701-8336 | 2005-10-11 |
| Find all providers in TYLER | ||||
Please comment or provide details below to improve the information on MICHAEL A SULLIVAN.
| 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.