MEDICARE: PATRICK C 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IL0119	OTHER		JOHN DEERE HEALTH PLAN
2	4796890015	OTHER		DMERC
3	20062	OTHER		IOWA HEALTH SOLUTIONS
4	034788	OTHER		HEALTH ALLIANCE
5	97782	OTHER	IA	WELLMARK BC/BS

General Provider Information

NPI Number	:	1548265556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK C CUNNINGHAM MD

Provider Business Mailing Address
First Line	:	865 LINCOLN RD
Second Line	:	STE L10
City	:	BETTENDORF
State	:	IA
Zip	:	52722-4159
Country	:	US
Telephone Number	:	563-355-9191
Fax Number	:	563-355-3419

Provider Business Practice Location Address
First Line	:	2560 24TH ST
Second Line	:	STE 202
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-5390
Country	:	US
Telephone Number	:	309-786-3395
Fax Number	:	309-779-3084

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/09/2007

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