Healthcare Provider Details

I. General information

NPI: 1689258667
Provider Name (Legal Business Name): KYLE SURBER-CUNNINGHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYLE CUNNINGHAM

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-232-4765
  • Fax:
Mailing address:
  • Phone: 734-232-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.077855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: