MICHAEL R DIBENEDETTO MD PLLC
Radiology at Highway 200, Ponderay, ID

License number
Idaho M10671
Category
Radiology
Type
Plastic and Reconstructive Surgery
Owner
Name: WENDY S BROSNAHAN
Title: OFFICE MANAGER
Phone: (208) 263-5900
Address
Address
30544 Highway 200 SUITE 102, Ponderay, ID 83852
National Provider ID: 1073757464
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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MICHAEL R. DIBENEDETTO, M.D., PLLC

30544 Hwy 200 STE 102, Ponderay, ID 83852

Registration:
Aug 19, 2002
State ID:
W20397
Business type:
Limited Liability Company

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