Provider Demographics
NPI:1053421057
Name:KAYE A CUNNINGHAM MD PC
Entity type:Organization
Organization Name:KAYE A CUNNINGHAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:AVARANN
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:928-768-2558
Mailing Address - Street 1:PO BOX 8368
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86427
Mailing Address - Country:US
Mailing Address - Phone:928-768-2558
Mailing Address - Fax:928-788-2039
Practice Address - Street 1:5653 HWY 95
Practice Address - Street 2:SUITE A
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426
Practice Address - Country:US
Practice Address - Phone:928-768-2558
Practice Address - Fax:928-788-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZZ8326207Q00000X
CAA71438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ514704Medicaid
CA27112533Medicaid
H18271Medicare UPIN
AZ514704Medicaid
CA27112533Medicaid