Provider Demographics
NPI:1619107810
Name:BIDWELL, MICHAEL E (ATC, L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:BIDWELL
Suffix:
Gender:M
Credentials:ATC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 E MIDDLE TPKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3730
Mailing Address - Country:US
Mailing Address - Phone:860-645-3810
Mailing Address - Fax:
Practice Address - Street 1:586 E MIDDLE TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3730
Practice Address - Country:US
Practice Address - Phone:860-645-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist