Provider Demographics
NPI:1033186903
Name:IDUN, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:IDUN
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:112 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1720
Practice Address - Country:US
Practice Address - Phone:717-267-7164
Practice Address - Fax:717-267-7414
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08022800174400000X
PAMD425631207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10156623 0002Medicaid
PA25-1716306OtherINTERGROUP
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherFIRST HEALTH
PAG920-0101/85XWCUOtherCAREFIRST
PA1928717OtherAETNA HMO
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAP00627622OtherRAILROAD MEDICARE
PA001828361OtherHIGHMARK BLUE SHIELD
PA50079823OtherCAPITAL BLUECROSS
PA7788804OtherAETNA NON-HMO
PA25-1716306OtherMULTIPLAN/PHCS
PAMD425631OtherMEDICAL LICENSE
PAPEARLOtherHEALTH AMERICA
PA2183091OtherMAMSI
PA25-1716306OtherDEVON
PA050514OtherMEDICARE GROUP #
PA120420418OtherDEPT OF LABOR
PA1573434OtherGATEWAY
PA240951OtherUNISON
PA25-1716306OtherINFORMED
PA25-1716306OtherINFORMED
PA2183091OtherMAMSI
PAPEARLOtherHEALTH AMERICA
PABI9399278OtherDEA