Provider Demographics
NPI:1780658989
Name:DUNQUE BLANKENBICKER, EMMELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMELINE
Middle Name:
Last Name:DUNQUE BLANKENBICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W. PINELOCH AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-481-7174
Mailing Address - Fax:407-481-7190
Practice Address - Street 1:1950 LEE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:407-647-5431
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32227OtherBCBS
FL252586100Medicaid