Provider Demographics
NPI:1942276944
Name:DUNKLE-BLATTER, STEPHANIE E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:DUNKLE-BLATTER
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 1:915 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-498-2311
Mailing Address - Fax:
Practice Address - Street 1:915 MICHIGAN ST STE 202
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-492-8431
Practice Address - Fax:937-492-3106
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40576208600000X
IN01066021A208600000X, 2086S0129X
OH35.121953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GROUP
KYASC1019OtherASC MEDICARE GROUP
KYP00397697OtherRR MEDICARE PIN
PA101266510Medicaid
KY36000818OtherASC MEDICAID GROUP
KY7100020980Medicaid
KY4000501OtherMEDICARE LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY0092721Medicare PIN
KYASC1019OtherASC MEDICARE GROUP
PA101266510Medicaid