Individual
DR. ANGELIQUE RENAE POLIDORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
19531 COCHRAN BLVD, PORT CHARLOTTE, FL 33948-2081
(941) 255-3535
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2010-01605
NC
207Q00000X
Family Medicine Physician
Primary
OS17556
FL
208D00000X
General Practice Physician
2010-01605
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010-01605
MEDICAL LICENSE
NC
05
—
5916841
—
NC
01
—
D09076700
CDS
NJ
Enumeration date
07/18/2007
Last updated
03/07/2023
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