Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 036036129 | IL |
NPI | 1205093697 |
---|---|
Provider Name | Dr. Myles P Cunningham |
First Address | Winnetka, IL 60093 |
Second Address | Winnetka, IL 60093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036036129 | (05) | IL |
336007108 | BCBS (01) | |
AC3853151 | DEA (01) | |
D12146 | (02) |