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General NPI Number Information
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NPI Number | 1578112983
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Entity Type | Individual
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Provider Name | PETER CUNNINGHAM D.P.M
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Gender | Male
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1 AUDUBON PLAZA DR OFC L2
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City | LOUISVILLE
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State | KY
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Zip | 40217-1318
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Country | US
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Telephone | 502-636-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE STE 308
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City | PEORIA
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State | IL
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Zip | 61614-5099
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Country | US
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Telephone | 309-691-6610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005968
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005968
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 246958
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License Number State | KY
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