Provider Demographics
NPI:1669444782
Name:BIDA-DUDUN, ANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:BIDA-DUDUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E. 1ST STREET, SUITE 215
Mailing Address - Street 2:KSB MEDICAL GROUP
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021
Mailing Address - Country:US
Mailing Address - Phone:815-285-5423
Mailing Address - Fax:815-285-5426
Practice Address - Street 1:215 E. 1ST STREET, SUITE 215
Practice Address - Street 2:KSB MEDICAL GROUP
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-285-5423
Practice Address - Fax:815-285-5426
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060145207V00000X
IL036-136200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036136200Medicaid
ILF400173706OtherMEDICARE
ILF400173706Medicare PIN
IL036136200Medicaid