MICHAEL W. SULLIVAN M.D. NPI 1275576944

NPI Information

NPI: 1275576944
Provider Name: MICHAEL W. SULLIVAN, M.D.
Classification: General Practice - 208D00000X
Entity Type: Individual
PECOS Registration: Yes
Address: 1600 SPEARHEAD DIVISION AVE DEPT 140
FORT KNOX, KY
ZIP 40122
Phone: (502) 613-4605

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NPI Details

Michael W. Sullivan, M.D. is a general practice in Fort Knox, KY. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Michael W. Sullivan, M.D. NPI is 1275576944. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1600 SPEARHEAD DIVISION AVE DEPT 140
FORT KNOX, KY
ZIP 40122-104
Phone: (502) 613-4605
Fax: (502) 613-4549

The NPI 1275576944 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/13/2006 and was last updated on 6/24/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	207Q00000X	Family Medicine	20770	NEBRASKA	No
2	207V00000X	Obstetrics & Gynecology	37645020	WISCONSIN	No
3	208D00000X	General Practice	30828	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	47600743612	MEDICAID	NEBRASKA
2	47600743621	MEDICAID	NEBRASKA
3	47600743622	MEDICAID	NEBRASKA
4	G27320	MEDICARE UPIN
5	47600743623	MEDICAID	NEBRASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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