MEDICARE: BLANCA LUCIA MARKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	5173	SD

General Provider Information

NPI Number	:	1184627036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA LUCIA MARKY MD

Provider Business Mailing Address
First Line	:	575 N SIOUX POINT RD
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5312
Country	:	US
Telephone Number	:	605-217-2667
Fax Number	:	605-217-2915

Provider Business Practice Location Address
First Line	:	601 N 30TH ST
Second Line	:	SUITE 5300
City	:	OMAHA
State	:	NE
Zip	:	68131-2137
Country	:	US
Telephone Number	:	402-280-5877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/14/2012

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