1. Home
  2. Directory
  3. Idaho
  4. Ponderay
  5. Surgery
  6. NPI Profile

SEASONS PLASTIC & RECONSTRUCTIVE SURGERY
NPI 1073757464
Surgery - Plastic and Reconstructive Surgery in Ponderay, ID

Active since April 29, 2009
30544 HIGHWAY 200, SUITE 102, PONDERAY, ID 83852(208) 263-5900(208) 263-1319 Get Directions Write a Review

NPPES record last updated: October 21, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Seasons Plastic & Reconstructive Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SEASONS PLASTIC & RECONSTRUCTIVE SURGERY (NPI 1073757464) is a healthcare organization registered as a plastic and reconstructive surgery in Ponderay, Idaho and active in the NPI registry since April 2009. The organization lists Wendy S Brosnahan, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1073757464
Entity TypeOrganization
Primary Taxonomy2086S0122X
Legal Business NameMICHAEL R DIBENEDETTO MD PLLC
Location Address30544 HIGHWAY 200, SUITE 102Ponderay, ID 83852-5005
Mailing Address30544 Highway 200, Suite 102Ponderay, ID 83852-5005 · (208) 263-5900 · Fax (208) 263-1319
Phone(208) 263-5900
Fax(208) 263-1319
Organization SubpartYes
Authorized OfficialWendy S BrosnahanOffice Manager · (208) 263-5900
Enumeration DateApril 29, 2009
Last NPPES UpdateOctober 21, 2009
✔ NPI 1073757464 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in ID · M10671
Definition
A surgeon who specializes in plastic and reconstructive surgery.
30544 HIGHWAY 200, Ponderay, ID 83852
Open in Google Maps ↗

Other Names 1

Doing Business AsSeasons Plastic & Reconstructive Surgery

Other Identifiers 3

Medicare PIN1106682ID
OtherDG3627ID · Rail Road Medicare
Other8N834ID · Blue Cross

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOAN M BLOOM M.D.
Family Medicine
30544 HIGHWAY 200, SUITE 102
PONDERAY, ID 83852
Bonner County (208) 265-9817
KAUAI IN-HOME THERAPY LLC
Clinic/Center (Physical Therapy)
30544 HIGHWAY 200
PONDERAY, ID 83852
Bonner County (808) 652-1954
TARA HEISEY LMT
Massage Therapist
30544 HIGHWAY 200
PONDERAY, ID 83852
Bonner County (208) 205-9559
BRUCE DEMKO CRNA INC
Nurse Anesthetist, Certified Registered
30544 HIGHWAY 200
PONDERAY, ID 83852
Bonner County (208) 255-8013
ANGELA ALICE CHAPIN MT
Massage Therapist
30544 HIGHWAY 200
PONDERAY, ID 83852
Bonner County (208) 255-9559
MICHAEL RAYMOND DIBENEDETTO M.D.
Orthopaedic Surgery
30544 HIGHWAY 200, STE 102
PONDERAY, ID 83852
Bonner County (208) 265-9817
MR. BRUCE WILLIAM DEMKO CRNA
Nurse Anesthetist, Certified Registered
30544 HIGHWAY 200
PONDERAY, ID 83852
Bonner County (208) 255-8013
PEND OREILLE SURGERY CENTER LLC
Clinic/Center (Ambulatory Surgical)
30544 HIGHWAY 200, SUITE 201
PONDERAY, ID 83852
Bonner County (208) 265-8194

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael R Dibenedetto MD PLLC's NPI number?

The NPI number for Michael R Dibenedetto MD PLLC is 1073757464. It was assigned to this organization in the NPPES registry on April 29, 2009. The provider is doing business as Seasons Plastic & Reconstructive Surgery.

Where is Michael R Dibenedetto MD PLLC located?

Michael R Dibenedetto MD PLLC is located at 30544 Highway 200 Suite 102, Ponderay, ID 83852. The listed phone number is (208) 263-5900.

What is Michael R Dibenedetto MD PLLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

When was this NPI record last updated?

The NPPES record for Michael R Dibenedetto MD PLLC was last updated on October 21, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.