Healthcare Provider Details

I. General information

NPI: 1346688512
Provider Name (Legal Business Name): MICHELLE ANNE CUNNINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8733
  • Fax:
Mailing address:
  • Phone: 314-226-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28296
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number28296
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85153
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: