Provider Demographics
NPI:1649531047
Name:DIBETTA, MICHELLE RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENEE
Last Name:DIBETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6150 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9712
Mailing Address - Country:US
Mailing Address - Phone:941-822-8777
Mailing Address - Fax:941-822-8770
Practice Address - Street 1:6150 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9712
Practice Address - Country:US
Practice Address - Phone:941-822-8777
Practice Address - Fax:941-822-8770
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME118512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine