Provider Demographics
NPI:1760447668
Name:CUNNINGHAM, WILLIAM C (DO)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 88121
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49518
Mailing Address - Country:US
Mailing Address - Phone:844-208-2798
Mailing Address - Fax:888-375-3106
Practice Address - Street 1:6683 S. STATE ROAD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846
Practice Address - Country:US
Practice Address - Phone:844-208-2798
Practice Address - Fax:888-375-3106
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2697628Medicaid
MIB95405Medicare UPIN