MEDICARE: DR. CARSON C CUNNINGHAM MD

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	208600000X	Surgery Physician	023960	LA
2	208600000X	Surgery Physician	2016007347	MO

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

General Provider Information

NPI Number	:	1861477218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARSON C CUNNINGHAM MD

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	3250 GORDONVILLE RD STE 384
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-5095
Country	:	US
Telephone Number	:	573-331-5522
Fax Number	:	573-331-5523

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/22/2021

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