Healthcare Provider Details

I. General information

NPI: 1073323945
Provider Name (Legal Business Name): MR. MICHAEL A CUNNINGHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 CLARK ST
MIDDLETOWN OH
45042-2041
US

IV. Provider business mailing address

314 CLARK ST
MIDDLETOWN OH
45042-2041
US

V. Phone/Fax

Practice location:
  • Phone: 937-608-0703
  • Fax:
Mailing address:
  • Phone: 937-608-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRS531494
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: