Provider Demographics
NPI:1427051622
Name:CUNNINGHAM, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:888-824-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361172392080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060471201Medicaid
LA1544558Medicaid
OK100030060AMedicaid
KY64926736Medicaid
NE100249681-00Medicaid
MO205132509Medicaid
OH2054226Medicaid
TN3812572Medicaid
VA6003010Medicaid
SCQ25982Medicaid
MS00119432Medicaid
AL009914460Medicaid
IA0527812Medicaid
AR133068001Medicaid
ME422400000Medicaid
NJ0030422Medicaid
NC7612992Medicaid
MO205132509Medicaid
VA6003010Medicaid