Provider Demographics
NPI:1659369577
Name:CUNNINGHAM, MICHAEL J (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1200 PROSPECT ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3362
Mailing Address - Country:US
Mailing Address - Phone:419-626-6006
Mailing Address - Fax:419-626-4038
Practice Address - Street 1:1200 PROSPECT STREET
Practice Address - Street 2:STE 103
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4793
Practice Address - Country:US
Practice Address - Phone:419-626-6006
Practice Address - Fax:419-626-4038
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34002087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212004Medicaid
D89586Medicare UPIN
OH0212004Medicaid