Provider Demographics
NPI:1538267844
Name:CUNNINGHAM, EDWIN JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JOHN
Last Name:CUNNINGHAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E
Other - Middle Name:J
Other - Last Name:CUNNINGHAM
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1585 WOODLAKE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5740
Mailing Address - Country:US
Mailing Address - Phone:314-434-3322
Mailing Address - Fax:314-469-2009
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-434-3322
Practice Address - Fax:314-469-2009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29021207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism