Healthcare Provider Details

I. General information

NPI: 1336324250
Provider Name (Legal Business Name): KRISTOPHER G CUNNINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4200
US

IV. Provider business mailing address

123 S 27TH ST
BILLINGS MT
59101-4200
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3350
  • Fax:
Mailing address:
  • Phone: 406-247-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11608
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: