Provider Demographics
NPI:1831695840
Name:CUNNINGHAM, STEPHAN (DPM)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 LAURENT DR APT 728
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5978
Mailing Address - Country:US
Mailing Address - Phone:203-214-3412
Mailing Address - Fax:
Practice Address - Street 1:5500 LAURENT DR APT 728
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5978
Practice Address - Country:US
Practice Address - Phone:203-214-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213E00000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist