Provider Demographics
NPI:1093980013
Name:CUNNINGHAM, BROOKE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 DELAWARE ST SE RM 420
Mailing Address - Street 2:MMC 381
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2959
Mailing Address - Country:US
Mailing Address - Phone:612-624-7244
Mailing Address - Fax:612-624-1466
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-638-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070657207R00000X
MN58542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD037007000Medicaid
MD191556Y82Medicare PIN