Organization
MICHAEL R DIBENEDETTO MD PLLC
Active
Other names
North Idaho Cardiac Rehabilitation, North Idaho Orthopedics & Sports Medicine, Woodlands Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL P GARMAN (PRACTICE MANAGER)
(208) 265-9817
Entity
Organization
Contact information
Practice address
30544 HWY 200, STE 102, PONDERAY, ID 83852
(208) 265-9836
(208) 263-7249
Mailing address
30544 HWY 200, STE 102, PONDERAY, ID 83852
(208) 265-9817
(208) 263-7249
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
261QR0404X
Cardiac Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140056
REGENCE BLUE SHIELD
ID
05
—
806452000
—
ID
01
—
8N259
BLUE CROSS
ID
01
—
DG3627
PALMETTO GBA RAILROAD MED
ID
Enumeration date
09/06/2007
Last updated
05/07/2021
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