| Michael W Sullivan, MD | |
|
1600 Spearhead Division Ave Dept 140, Fort Knox, KY 40122-5104 | |
| (502) 613-4605 | |
| (502) 613-4549 |
| Full Name | Michael W Sullivan |
|---|---|
| Gender | Male |
| Speciality | General Practice |
| Location | 1600 Spearhead Division Ave Dept 140, Fort Knox, Kentucky |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275576944 | NPI | - | NPPES |
| 47600743623 | Medicaid | NE | |
| 47600743612 | Medicaid | NE | |
| 47600743621 | Medicaid | NE | |
| 47600743622 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20770 (Nebraska) | Secondary |
| 207V00000X | Obstetrics & Gynecology | 37645020 (Wisconsin) | Secondary |
| 208D00000X | General Practice | 30828 (Kentucky) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Michael W Sullivan, MD 1600 Spearhead Division Ave Dept 140, Fort Knox, KY 40122-5104 Ph: (502) 613-4605 | Michael W Sullivan, MD 1600 Spearhead Division Ave Dept 140, Fort Knox, KY 40122-5104 Ph: (502) 613-4605 |
Dr. Vanessa Jane Shank, M.D. General Practice Medicare: Medicare Enrolled Practice Location: 289 Ireland Ave, Ireland Army Community Hospital, Fort Knox, KY 40121 Phone: 502-624-9864 |