Healthcare Provider Details

I. General information

NPI: 1013962612
Provider Name (Legal Business Name): LISA CUNNINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 TENDERFOOT HILL ST SUITE 100
COLORADO SPRINGS CO
80906-3981
US

IV. Provider business mailing address

2620 TENDERFOOT HILL ST SUITE 100
COLORADO SPRINGS CO
80906-3981
US

V. Phone/Fax

Practice location:
  • Phone: 719-576-7006
  • Fax: 719-576-7981
Mailing address:
  • Phone: 719-576-7006
  • Fax: 719-576-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31239
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: