Individual
ELIZABETH A CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7165 CLEARVISTA WAY, INDIANAPOLIS, IN 46256-4621
(317) 621-7804
(317) 621-7275
Mailing address
6626 E 75TH STREET, STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7561
(317) 355-6096
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
02003893A
IN
2084P0800X
Psychiatry Physician
R836
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000749766
ANTHEM BCBS
IN
01
—
000000750186
ANTHEM BCBS
IN
05
—
100270530
—
IN
05
—
201045350
—
IN
01
—
P01191797
RR MEDICARE PTAN
IN
Enumeration date
06/13/2007
Last updated
11/27/2023
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