Healthcare Provider Details

I. General information

NPI: 1336075548
Provider Name (Legal Business Name): HEALTHSTAR MEDICAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 W VAN BUREN ST STE 114
AVONDALE AZ
85323-5317
US

IV. Provider business mailing address

9950 W VAN BUREN ST STE 114
AVONDALE AZ
85323-5317
US

V. Phone/Fax

Practice location:
  • Phone: 424-322-9032
  • Fax:
Mailing address:
  • Phone: 424-322-9032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN PENWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 424-322-9032