Healthcare Provider Details

I. General information

NPI: 1780188789
Provider Name (Legal Business Name): KENDALL CUNNINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 THEDA CLARK MEDICAL PLZ STE 210
NEENAH WI
54956-2790
US

IV. Provider business mailing address

200 THEDA CLARK MEDICAL PLZ STE 210
NEENAH WI
54956-2790
US

V. Phone/Fax

Practice location:
  • Phone: 920-364-2986
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number87265-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: