Individual
MRS. CORY CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
15901 CICERO AVE, OAK FOREST, IL 60452-4005
(708) 633-1968
Mailing address
14707 LE CLAIRE AVE, MIDLOTHIAN, IL 60445-3570
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-001648
IL
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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