Individual
THOMAS MICHAEL POLIDORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 MEDICAL PLAZA DR STE 130, ROSEVILLE, CA 95661-3088
(916) 773-8750
(916) 797-4774
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G83054
CA
208C00000X
Colon & Rectal Surgery Physician
G83054
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
OOG830540
—
CA
Enumeration date
11/17/2005
Last updated
01/11/2018
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