Provider Demographics
NPI:1841291317
Name:DUDAS, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:DUDAS
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 1:2671 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5041
Mailing Address - Country:US
Mailing Address - Phone:206-525-8000
Mailing Address - Fax:206-525-8070
Practice Address - Street 1:2671 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5041
Practice Address - Country:US
Practice Address - Phone:206-525-8000
Practice Address - Fax:206-525-8070
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7166DUOtherBLUE SHIELD
WA8219859Medicaid
WA0039577OtherLABOR AND INDUSTRIES#
WAUS5038593OtherAETNA PCP PIN
WAUS5038593OtherAETNA PCP PIN
WA8219859Medicaid