Provider Demographics
NPI:1649339722
Name:CUNNINGHAM, SCOTT KENNETH (M D)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:KENNETH
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3540 S POPLAR ST
Mailing Address - Street 2:STE 305
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1360
Mailing Address - Country:US
Mailing Address - Phone:303-770-0524
Mailing Address - Fax:303-770-0648
Practice Address - Street 1:3540 S POPLAR ST
Practice Address - Street 2:STE 305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-1360
Practice Address - Country:US
Practice Address - Phone:303-770-0524
Practice Address - Fax:303-770-0648
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO30078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
998688Medicare UPIN