Provider Demographics
NPI:1235972274
Name:SULLIVAN, CHRISTOPHER KIRK
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KIRK
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 N GLENOAKS DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-1601
Mailing Address - Country:US
Mailing Address - Phone:903-436-2141
Mailing Address - Fax:
Practice Address - Street 1:3005 N GLENOAKS DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-1601
Practice Address - Country:US
Practice Address - Phone:903-436-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator