| Organization Name: | MICHAEL R DIBENEDETTO MD PLLC |
| NPI Number: | 1073757464 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WENDY S BROSNAHAN (OFFICE MANAGER) |
| Mailing Address: | 30544 Highway 200 Suite 102 Ponderay |
| State: | ID US |
| Postal Code: | 838525005 |
| Phone Number: | 2082635900 |
| Fax Number: | 2082631319 |
| NPI Enumeration Date: | 04/29/2009 |
| NPI Last Update Date: | 10/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | M10671 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |