MEDICARE: KAYE A CUNNINGHAM MD PC

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	A71438	CA
2	207Q00000X	Family Medicine Physician	Z8326	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053421057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYE A CUNNINGHAM MD PC

Provider Business Mailing Address
First Line	:	PO BOX 8368
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86427
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:	928-788-2039

Provider Business Practice Location Address
First Line	:	5653 HWY 95
Second Line	:	SUITE A
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:	928-788-2039

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	DR. KAYE AVARANN CUNNINGHAM
Credential	:	MD PC
Telephone Number	:	928-768-2558

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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