Provider Demographics
NPI:1366709354
Name:CUNNINGHAM, LINDSAY (DO)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721602
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8231
Mailing Address - Country:US
Mailing Address - Phone:918-935-2775
Mailing Address - Fax:539-867-1681
Practice Address - Street 1:2622 E 21ST ST STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1738
Practice Address - Country:US
Practice Address - Phone:918-935-2775
Practice Address - Fax:539-867-1681
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5417207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200519280BMedicaid