Provider Demographics
NPI:1346688512
Name:CUNNINGHAM, MICHELLE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
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:NSA SOUDA BAY
Mailing Address - Street 2:DET 1, 95 RS
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09266
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NSA SOUDA BAY
Practice Address - Street 2:DET 1, 95 RS
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09266
Practice Address - Country:US
Practice Address - Phone:282-102-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28296207Q00000X, 2083A0100X
SC85153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine