MEDICARE: SEAN M CUNNINGHAM DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101022669	MI

General Provider Information

NPI Number	:	1023469590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN M CUNNINGHAM DO

Provider Business Mailing Address
First Line	:	15151 STANTON ST
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8543
Country	:	US
Telephone Number	:	616-685-1950
Fax Number	:	616-685-1980

Provider Business Practice Location Address
First Line	:	15151 STANTON ST
Second Line	:
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8543
Country	:	US
Telephone Number	:	616-685-1950
Fax Number	:	231-727-5223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	12/31/2021

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