Provider Demographics
NPI:1699728535
Name:DUNLANY, SAMUEL C (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:DUNLANY
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 78
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47701-0078
Mailing Address - Country:US
Mailing Address - Phone:800-467-2392
Mailing Address - Fax:812-471-6650
Practice Address - Street 1:1400 ROBIN RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2845
Practice Address - Country:US
Practice Address - Phone:270-929-5716
Practice Address - Fax:270-685-6097
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64174642Medicaid
KYC69392Medicare UPIN
KY1755401Medicare ID - Type Unspecified