OrganizationActive
Michael R Dibenedetto MD PLLC
NPI 1073757464 · Plastic and Reconstructive Surgery Physician · Ponderay, ID
Provider details
- NPI number
- 1073757464
- Entity type
- Organization
- Primary specialty
- Plastic and Reconstructive Surgery PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Michael R Dibenedetto MD PLLC
- Authorized official
- Wendy Brosnahan, Office Manager
- License
- M10671 (ID)
Practice location
30544 Highway 200
Suite 102
Ponderay, ID 83852-5005
Phone: (208) 263-5900
Fax: (208) 263-1319
Mailing address
30544 Highway 200
Ponderay, ID 83852-5005
Registry dates
- Enumerated
- 2009-04-29
- Last updated
- 2009-10-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.