Provider Demographics
NPI:1316188048
Name:DIBIASE, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DIBIASE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1551 BISHOP ST BLDG A STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4692
Mailing Address - Country:US
Mailing Address - Phone:805-548-8585
Mailing Address - Fax:805-548-8589
Practice Address - Street 1:1551 BISHOP ST BLDG A STE 110
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4692
Practice Address - Country:US
Practice Address - Phone:805-548-8585
Practice Address - Fax:805-548-8589
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine