Provider Demographics
NPI:1649247545
Name:BIDIKOV, IGOR (MD)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:BIDIKOV
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 1:40 GILES ST
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-1738
Mailing Address - Country:US
Mailing Address - Phone:256-463-7454
Mailing Address - Fax:256-463-7725
Practice Address - Street 1:40 GILES ST
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1738
Practice Address - Country:US
Practice Address - Phone:256-463-7454
Practice Address - Fax:256-463-7725
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20761207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935160Medicaid
AL000095514Medicare PIN
ALG57975Medicare UPIN