Basic Information
| Provider Information | |||||||||
| NPI: | 1942276944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNKLE-BLATTER | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374982311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 MICHIGAN ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453652401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374928431 | ||||||||
| FaxNumber: | 9374923106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 40576 | KY | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 01066021A | IN | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 01066021A | IN | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 35.121953 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 37903705 | 01 | KY | MEDICAID LAB GROUP | OTHER | ASC1019 | 01 | KY | ASC MEDICARE GROUP | OTHER | P00397697 | 01 | KY | RR MEDICARE PIN | OTHER | 101266510 | 05 | PA | MEDICAID | 36000818 | 01 | KY | ASC MEDICAID GROUP | OTHER | 7100020980 | 05 | KY | MEDICAID | 4000501 | 01 | KY | MEDICARE LAB GROUP | OTHER | CB5773 | 01 | KY | RR MEDICARE GROUP | OTHER |