Healthcare Provider Details

I. General information

NPI: 1104069137
Provider Name (Legal Business Name): CLAIRE IDA A CUNDIFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 08/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 A AVENUE NE
CEDAR RAPIDS IA
52402
US

IV. Provider business mailing address

855 A AVENUE NE SUITE 200
CEDAR RAPIDS IA
52402
US

V. Phone/Fax

Practice location:
  • Phone: 319-391-5501
  • Fax: 319-743-2610
Mailing address:
  • Phone: 319-391-5501
  • Fax: 319-743-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43936
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-14677
License Number StateHI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: