Individual
MRS. MARIA LOUISE CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Mailing address
916 TALON DR, SUITE 102, O FALLON, IL 62269-1848
(618) 628-8211
(618) 628-0883
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
070018731
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146703
MEDICARE PART A
IL
01
—
900068033
HNFS TRICARE NORTH REGION
IL
Enumeration date
10/12/2011
Last updated
12/19/2011
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