Most Relevant Information
Provider Data
| NPI Number: | 1003479270 |
| Provider Name: | KELLEN A. SULLIVAN MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207R00000X |
| Specialty: | Internal Medicine |
| License Number: | 11898972-1205 |
Most Important Dates
| Enumeration Date: | 04/15/2019 |
| Last Updated: | 08/24/2020 |
Provider Practice Location
30 N 1900 E RM 4C116
SALT LAKE CITY
UT
841320002
Practice Location Phone/Fax
| Phone: | 8015817606 |
| Fax: |
Provider Mailing Location
30 N 1900 E RM 4C116
SALT LAKE CITY
UT
841320002
Provider Mailing Phone/Fax
| Phone: | 8015817606 |
| Fax: |
Suggested EMR
Internist EMR