Basic Information
| Provider Information | |||||||||
| NPI: | 1750413175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIBELLA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 LUCE AVE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484331715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106597592 | ||||||||
| FaxNumber: | 8106597202 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 E HOUGHTON AVE | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486611127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893433124 | ||||||||
| FaxNumber: | 9893433165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 4301062732 | MI | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.