MEDICARE: DR. CHARLES CASEY CUNNINGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G3263	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R1421	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1144216250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES CASEY CUNNINGHAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-999-7800
Fax Number	:	972-234-0813

Provider Business Practice Location Address
First Line	:	3535 WORTH ST
Second Line	:	SUITE 302
City	:	DALLAS
State	:	TX
Zip	:	75246-2006
Country	:	US
Telephone Number	:	214-370-1870
Fax Number	:	214-370-1860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/25/2008

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