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Contact Information

MICHAEL R DIBENEDETTO MD PLLC
30544 HWY 200
STE 102
PONDERAY, ID83852
 Phone: 208-265-9836
 Fax: 208-263-7249
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Rehabilitation: Cardiac Facilities

261QR0404X
Indicates primary specialty

NPI Profile & details for MICHAEL R DIBENEDETTO MD PLLC · (Female)

NPI # 1083809727
Status Active
Credentials
Entity Individual
Enumeration date 09/06/2007
Last updated 05/07/2021 - About 5 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID Medicaid 806452000
  • ID Other 8N259 BLUE CROSS
  • ID Other DG3627 PALMETTO GBA RAILROAD MED
  • ID Other 000010140056 REGENCE BLUE SHIELD
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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