Michael R Dibenedetto MD PLLC
Orthopaedic Surgery in Ponderay, ID. Organization (NPI-2).
NPI number1083809727
StatusActive
Last updated in NPPESJun 30, 2026
Details
- NPI
- 1083809727
- Entity type
- Organization (NPI-2)
- Legal business name
- Michael R Dibenedetto MD PLLC
- Organization subpart
- No
- Enumeration date
- Sep 6, 2007
- Certification date
- Jun 30, 2026
- Last updated
- Jun 30, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | – | – | Yes |
| 261QR0404X | Clinic/Center, Rehabilitation, Cardiac Facilities | – | – |
Other names
- North Idaho Orthopedics & Sports Medicine (Doing Business As)
- Woodlands Family Medicine (Doing Business As)
- North Idaho Cardiac Rehabilitation (Doing Business As)
Practice location
30544 Hwy 200Ste 102
Ponderay, ID 83852
Phone 208-265-9836 · Fax 208-263-7249
Mailing address
30544 Highway 200 Ste 102Ponderay, ID 83852-5005
Phone 208-265-9817 · Fax 208-265-4533
Authorized official
Kirsten Eveland
Practice Manager
2082659817
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