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General NPI Number Information
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NPI Number | 1700080561
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Entity Type | Individual
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Provider Name | ELIZABETH A CUNNINGHAM DO
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 7165 CLEARVISTA WAY
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4621
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Country | US
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Telephone | 317-621-7804
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Fax | 317-621-7275
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Provider Business Mailing Address
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Address Line | 6626 E 75TH STREET STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone | 317-621-7561
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Fax | 317-355-6096
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R836
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 02003893A
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License Number State | IN
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