Provider Demographics
NPI:1841340270
Name:CUNNINGHAM, JAMES MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PACIFIC AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1056
Mailing Address - Country:US
Mailing Address - Phone:712-563-4611
Mailing Address - Fax:712-563-2498
Practice Address - Street 1:515 PACIFIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1056
Practice Address - Country:US
Practice Address - Phone:712-563-4611
Practice Address - Fax:712-563-2498
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0224782Medicaid
IAA02624Medicare UPIN
IAI0638Medicare ID - Type UnspecifiedMEDICARE PART B