MEDICARE: SILVERCARE MEDICAL GROUP, INC

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	208D00000X	General Practice Physician	FNP32158	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FNP32158	OTHER	CA	FICTITIOUS NAME PERMIT
2	01904	OTHER	CA	CITY OF THOUSAND OAKS ID

General Provider Information

NPI Number	:	1427096197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERCARE MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	8306 WILSHIRE BLVD
Second Line	:	#501
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2382
Country	:	US
Telephone Number	:	805-494-8430
Fax Number	:	805-494-8379

Provider Business Practice Location Address
First Line	:	45 ERBES RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-5802
Country	:	US
Telephone Number	:	805-494-8430
Fax Number	:	805-494-8379

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEXANDER DUSOVICH
Credential	:	M.D.
Telephone Number	:	310-613-2414

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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