MEDICARE: DR. MICHAEL A DIBARTOLO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	6440	AK
2	207Q00000X	Family Medicine Physician	OP60496207	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316999808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A DIBARTOLO DO

Provider Business Mailing Address
First Line	:	950 E BOGARD RD STE 103
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7184
Country	:	US
Telephone Number	:	907-352-2880
Fax Number	:	907-352-2885

Provider Business Practice Location Address
First Line	:	950 E BOGARD RD STE 103
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7184
Country	:	US
Telephone Number	:	907-352-2880
Fax Number	:	907-352-2885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	12/05/2022

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Directions to “ DR. MICHAEL A DIBARTOLO DO” Practice Location

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