Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | MD060320L | PA |
Y | 207VX0201X | Gynecologic Oncologist | MD60391889 | WA |
NPI | 1235192584 |
---|---|
Provider Name | Dr. Michael Allan Bidus |
First Address | Laurel, MD 20724-6123 |
Second Address | Gig Harbor, WA 98332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 22/05/2018 |