Provider Demographics
NPI:1144380221
Name:ANNA BIDA-DUDUN, MD, PC
Entity Type:Organization
Organization Name:ANNA BIDA-DUDUN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-922-0680
Mailing Address - Street 1:1629 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3542
Mailing Address - Country:US
Mailing Address - Phone:248-649-2266
Mailing Address - Fax:248-649-7246
Practice Address - Street 1:1629 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3542
Practice Address - Country:US
Practice Address - Phone:248-649-2266
Practice Address - Fax:248-649-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
G30181Medicare UPIN
0P39520Medicare ID - Type Unspecified