Healthcare Provider Details

I. General information

NPI: 1841291317
Provider Name (Legal Business Name): MICHAEL S DUDAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 NE 46TH ST
SEATTLE WA
98105-5041
US

IV. Provider business mailing address

2671 NE 46TH ST
SEATTLE WA
98105-5041
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-8000
  • Fax: 206-525-8070
Mailing address:
  • Phone: 206-525-8000
  • Fax: 206-525-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00034162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: