Active NPI
Mark Douglas Cunningham, D.O.
- Family Medicine Physician
- Red Lake, MN
National Provider Identifier
1548290950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 42179
- Practice address
- Highway 1
Red Lake, MN 56671-0249 - Phone
- (218) 679-3912
- Fax
- (218) 679-0135
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 42179 | MN | Primary |
Addresses
Primary practice location
Highway 1
Red Lake, MN 56671-0249
Mailing address
Hwy 1
24760 Hospital Drive
Red Lake, MN 56671-0249
Phone (218) 679-3912
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42179 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1548290950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HWY 1",
"address_2": "24760 HOSPITAL DRIVE",
"city": "RED LAKE",
"state": "MN",
"postal_code": "566710249",
"telephone_number": "218-679-3912",
"fax_number": "218-679-0135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HIGHWAY 1",
"city": "RED LAKE",
"state": "MN",
"postal_code": "566710249",
"telephone_number": "218-679-3912",
"fax_number": "218-679-0135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUNNINGHAM",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "42179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.