MEDICARE: DR. GREGG POLIDORI MD

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	207RG0100X	Gastroenterology Physician	4301407183	MI

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

General Provider Information

NPI Number	:	1689665465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG POLIDORI MD

Provider Business Mailing Address
First Line	:	3535 W 13 MILE RD
Second Line	:	STE 202
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-0900
Fax Number	:	248-551-0905

Provider Business Practice Location Address
First Line	:	3535 W 13 MILE RD
Second Line	:	STE 202
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-0900
Fax Number	:	248-551-0905

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	10/20/2020

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Directions to “ DR. GREGG POLIDORI MD” Practice Location

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