| Doctor Name: | DR. MICHAEL J DICLEMENTE |
| NPI Number: | 1639160088 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 212771 |
| Business Practice Address: | 3101 Hwy 71 E Suite 107 Bastrop, TX - 78602 |
| Business Phone Number: | 5129856972 |
| Business Fax Number: | 5129855840 |
| Mailing Address: | 3101 Hwy 71 E, Suite 101 BASTROP |
| State: | TX |
| Postal Code: | 78602 |
| Phone Number: | 5123040300 |
| Fax Number: | 5123010341 |
| NPI Enumeration Date: | 11/03/2005 |
| NPI Last Update Date: | 04/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 212771 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |