Provider Demographics
NPI:1578590048
Name:CUNNINGHAM, BRUCE LANGDON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LANGDON
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 195
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-1188
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:606 24TH AVENUE SOUTH, SECOND FLOOR, SUITE 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-273-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25623208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1000600OtherPREFERRED ONE
MN13-70029OtherMEDICA PRIMARY
MN275500900Medicaid
IA0977173Medicaid
MNHP13115OtherHEALTHPARTNERS
MN2T090CUOtherBCBS
MN13-22593OtherMEDICA CHOICE
MN768074OtherARAZ
MN101572OtherUCARE
MNA93641OtherUPIN