Healthcare Provider Details

I. General information

NPI: 1467475046
Provider Name (Legal Business Name): MICHAEL THOMAS MARGOLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/26/2023
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 POLLARD RD
LOS GATOS CA
95032-1435
US

IV. Provider business mailing address

101 S SAN MATEO DR STE 102
SAN MATEO CA
94401-3840
US

V. Phone/Fax

Practice location:
  • Phone: 408-370-9098
  • Fax: 650-422-3685
Mailing address:
  • Phone: 650-375-1644
  • Fax: 650-422-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberG83323
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG83323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: