MEDICARE: DR. RUTHANN M CUNNINGHAM M.D.

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	207P00000X	Emergency Medicine Physician	42177	WI
2	207P00000X	Emergency Medicine Physician	G89027	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42177	OTHER	WI	MD LICENSE

General Provider Information

NPI Number	:	1427048552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTHANN M CUNNINGHAM M.D.

Provider Business Mailing Address
First Line	:	3801 SPRING ST
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-1667
Country	:	US
Telephone Number	:	262-687-4479
Fax Number	:	262-687-5375

Provider Business Practice Location Address
First Line	:	8767 WILSHIRE BLVD FL 3
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2714
Country	:	US
Telephone Number	:	310-385-6031
Fax Number	:

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	12/22/2023

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