MEDICARE: MRS. KATHERINE LOUISE CUNNINGHAM P.A.

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	363AM0700X	Medical Physician Assistant	85002689	IL

General Provider Information

NPI Number	:	1619923315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE LOUISE CUNNINGHAM P.A.

Provider Business Mailing Address
First Line	:	111 S MORGAN ST
Second Line	:	APT 915
City	:	CHICAGO
State	:	IL
Zip	:	60607-2724
Country	:	US
Telephone Number	:	773-474-6855
Fax Number	:

Provider Business Practice Location Address
First Line	:	2266 N LINCOLN AVE
Second Line	:	3RD FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60614-3718
Country	:	US
Telephone Number	:	773-281-3670
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	02/25/2008

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