MEDICARE: KAYE A CUNNINGHAM MD

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	207Q00000X	Family Medicine Physician	28326	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447435417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYE A CUNNINGHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 8368
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86427-8368
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	5653 S HIGHWAY 95
Second Line	:	STE A
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6068
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:

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

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	01/08/2008

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