Michael R Dibenedetto MD PLLC
Michael R Dibenedetto MD PLLC is a Plastic and Reconstructive Surgery Physician in Ponderay, Idaho. Licensed in Idaho. Registered with an NPI since 2009.
- Licensed in
- ID
- In the registry since
- 2009
What do these letters mean?
- PLLC — Professional limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
30544 Highway 200 Ste 102Ponderay, ID 83852-5005
Phone: (208) 263-5900
Fax: (208) 263-1319
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Plastic and Reconstructive Surgery Physician (primary) | Taxonomy 2086S0122X · Licence M10671 (ID) |
|---|
Record details
| NPI number | 1073757464 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | Yes |
| Parent organization | Michael R Dibenedetto MD PLLC |
| Authorized official | Wendy Brosnahan — Office Manager · (208) 263-5900 |
| Other names | Seasons Plastic & Reconstructive Surgery |
| NPI enumerated | April 29, 2009 |
| Last updated in NPPES | October 21, 2009 |
| Mailing address | 30544 Highway 200, Suite 102, Ponderay, ID 83852-5005 |