institution
Michael R Dibenedetto Md Pllc
Plastic and Reconstructive Surgery Physician in Ponderay, Idaho
NPI 1073757464

Michael R Dibenedetto Md Pllc is a Plastic and Reconstructive Surgery Physician based in Ponderay, ID and is specialized in Plastic and Reconstructive Surgery. Michael R Dibenedetto Md Pllc practices in Ponderay, ID. The NPI Number for Michael R Dibenedetto Md Pllc is 1073757464 and holds a License No. M10671 (Idaho).

The current practice location address for Michael R Dibenedetto Md Pllc is 30544 Highway 200, Ponderay, ID and can be reached out via phone at 208-263-5900 and via fax at 208-263-1319. You can also correspond with Michael R Dibenedetto Md Pllc through the mailing address at 30544 HIGHWAY 200, PONDERAY, ID - 83852-5005 (mailing address contact number: 208-263-5900).

Location: 30544 Highway 200, Ponderay, ID, 83852-5005
institution
Provider Profile Details
NPI Number
1073757464
Provider Name
Michael R Dibenedetto Md Pllc
Credential
Provider Entity Type
Organization
Address
30544 Highway 200, Ponderay, ID, 83852-5005
Phone Number
208-263-5900
Fax Number
208-263-1319
Provider Enumeration Date
04/29/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
DG3627 01 ID RAIL ROAD MEDICARE
8N834 01 ID BLUE CROSS
institution
Provider Business Practice Location Address Details
Address
30544 Highway 200
City
State
Zip
83852-5005
Phone Number
208-263-5900
Fax Number
208-263-1319
person
Provider Business Mailing Address Details
Address
30544 Highway 200
City
State
Zip
83852-5005
Phone Number
208-263-5900
Fax Number
208-263-1319
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Plastic and Reconstructive Surgery
Taxonomy
License No.
M10671 (Idaho)
Definition
A surgeon who specializes in plastic and reconstructive surgery.
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