Provider Demographics
NPI:1205093697
Name:CUNNINGHAM, MYLES P (MD)
Entity type:Individual
Prefix:DR
First Name:MYLES
Middle Name:P
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:31 WOODLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-446-2524
Mailing Address - Fax:847-446-2577
Practice Address - Street 1:31 WOODLEY ROAD
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-446-2524
Practice Address - Fax:847-446-2577
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360361292086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036036129Medicaid
336007108OtherBCBS
AC3853151OtherDEA
IL036036129Medicaid
D12146Medicare UPIN