Basic Information
Provider Information
NPI: 1003802166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SULMAN
FirstName: CECILLE
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9000 W WISCONSIN AVE
Address2: DIVISION OF PEDIATRIC OTOLARYNGOLOGY
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: 4142666467
FaxNumber: 4142662693
Practice Location
Address1: 9000 W WISCONSIN AVE
Address2: DIVISION OF PEDIATRIC OTOLARYNGOLOGY
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: 4142666467
FaxNumber: 4142662693
Other Information
ProviderEnumerationDate: 09/23/2005
LastUpdateDate: 09/29/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000X036-110180ILN Allopathic & Osteopathic PhysiciansOtolaryngology 
207YP0228X49373WIY Allopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology

ID Information
IDTypeStateIssuerDescription
036-11018005IL MEDICAID
100380216605WI MEDICAID


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