Provider Demographics
NPI:1881670677
Name:DUNLAP, STEVEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:DUNLAP
Suffix:
Gender:M
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:PO BOX 606
Mailing Address - Street 2:122 COMMERCE AVENUE
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006
Mailing Address - Country:US
Mailing Address - Phone:830-249-0130
Mailing Address - Fax:830-249-0124
Practice Address - Street 1:122 COMMERCE
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2073
Practice Address - Country:US
Practice Address - Phone:830-249-0130
Practice Address - Fax:830-249-0124
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075840207R00000X
TXN2479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075840Medicaid
IL5715384OtherBLUE CROSS BLUE SHIELD
IL5715384OtherBLUE CROSS BLUE SHIELD
ILL71059Medicare PIN
IL036075840Medicaid