Provider Demographics
NPI:1437597846
Name:CUNNINGHAM, MICHELLE ALISSA (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALISSA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:509 HAMACHER STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298
Mailing Address - Country:US
Mailing Address - Phone:618-939-3939
Mailing Address - Fax:618-939-0234
Practice Address - Street 1:509 HAMACHER STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298
Practice Address - Country:US
Practice Address - Phone:618-939-3939
Practice Address - Fax:618-939-0234
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125062914208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics