Individual
DR. MICHAEL A DIBARTOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
950 E BOGARD RD STE 103, WASILLA, AK 99654-7184
(907) 352-2880
(907) 352-2885
Mailing address
950 E BOGARD RD STE 103, WASILLA, AK 99654-7184
(907) 352-2880
(907) 352-2885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6440
AK
207Q00000X
Family Medicine Physician
Primary
OP60496207
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD1623
—
AK
01
—
MDG798
MEDICAID GROUP #
AK
Enumeration date
05/16/2006
Last updated
12/05/2022
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