Provider Demographics
NPI:1003259136
Name:CUNNINGHAM, PATRICK (BUILDING CONTRACTOR)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:BUILDING CONTRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11595 NE COUNTY ROAD 237
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-5235
Mailing Address - Country:US
Mailing Address - Phone:352-494-2300
Mailing Address - Fax:
Practice Address - Street 1:11595 NE COUNTY ROAD 237
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-5235
Practice Address - Country:US
Practice Address - Phone:352-494-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBC059880171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690070400Medicaid