NPI 1073757464

Michael R Dibenedetto MD PLLC

Organisation Plastic and Reconstructive Surgery Physician Ponderay, ID

Practice location

Address: 30544 Highway 200 Suite 102, Ponderay, ID 83852-5005
Phone: (208) 263-5900
Fax: (208) 263-1319

Authorised official

Name: Wendy S Brosnahan
Title: Office Manager
Phone: (208) 263-5900

Registered specialties

Plastic and Reconstructive Surgery Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2086S0122X Licence M10671 (ID)

Other Surgery providers in Idaho →

Registry record

NPI: 1073757464
Entity type: Organization
NPI issued: 29 Apr 2009
Record last updated: 21 Oct 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.