Provider Demographics
NPI:1902873821
Name:BIDIKOV, TATIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:
Last Name:BIDIKOV
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 1:1300 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4614
Mailing Address - Country:US
Mailing Address - Phone:256-237-0023
Mailing Address - Fax:256-237-9022
Practice Address - Street 1:1300 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4614
Practice Address - Country:US
Practice Address - Phone:256-237-0023
Practice Address - Fax:256-237-9022
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20762208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935140Medicaid
ALG56392Medicare UPIN