Healthcare Provider Details

I. General information

NPI: 1235192584
Provider Name (Legal Business Name): MICHAEL ALLAN BIDUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 CANTERWOOD BLVD NW STE 100
GIG HARBOR WA
98332
US

IV. Provider business mailing address

8166 MISSISSIPPI RD
LAUREL MD
20724-6123
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8150
  • Fax: 253-382-8155
Mailing address:
  • Phone: 240-418-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD60391889
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD060320L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: