Provider Demographics
NPI:1336140078
Name:CUNNINGHAM, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1000
Mailing Address - Country:US
Mailing Address - Phone:601-450-0521
Mailing Address - Fax:
Practice Address - Street 1:5000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1000
Practice Address - Country:US
Practice Address - Phone:601-450-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350847232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000327390OtherBC/BS INDIVIDUAL PIN NO
KY64097025Medicaid
OH2535484Medicaid
OHP00138530OtherSOR RR MDCR PIN NUMBER
OHP00181684OtherSOM RR MDCR PIN NUMBER
KY64097025Medicaid
OHP00138530OtherSOR RR MDCR PIN NUMBER
I10592Medicare UPIN