Provider Demographics
NPI:1578510954
Name:CUNNINGHAM, EDWIN J (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9434
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-9434
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7638
Practice Address - Street 1:3801 S NATIONAL AVE
Practice Address - Street 2:WEST TOWER, SUITE 700
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-881-7638
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4587207T00000X
OH82517207T00000X
MO2005013024207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0215052OtherDEPARTMENT OF LABOR WA
MO106461OtherHEALTHLINK
MOH91289OtherUSPS (W/C)
MO23274OtherCOX HEALTH PLANS UPI
AR5N434OtherARKANSAS BC/BS
AR5N434OtherARKANSAS FIRST SOURCE
AR6060020300OtherQUAL CHOICE
MO207278102Medicaid
AR5N434OtherHEALTH ADVANTAGE
MO8719997003OtherCIGNA HEALTHCARE
MO198370OtherBLUE CROSS/CHOICE
MO2305711OtherUNITED HEALTHCARE
AR159350001Medicaid
MO4188130001OtherCIGNA MEDICARE
MO2305711OtherUNITED HEALTHCARE
MOH91289Medicare UPIN
MOH91289OtherUSPS (W/C)
AR5N434OtherARKANSAS BC/BS
MOP00245009Medicare PIN
MOMA3058007Medicare PIN
AR5N434OtherHEALTH ADVANTAGE
AR5N434OtherARKANSAS FIRST SOURCE