Provider Demographics
NPI:1821219106
Name:CUNNINGHAM, MICHAEL CULLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CULLEN
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 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2129
Mailing Address - Country:US
Mailing Address - Phone:228-392-7429
Mailing Address - Fax:228-396-3830
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 340
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-392-7429
Practice Address - Fax:228-396-3830
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19714207RI0011X
LAMD.15474R207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08806571Medicaid
MS7461908OtherATENA
MSP00630623OtherRAILROAD
LA1067156Medicaid
MS08806571Medicaid