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General NPI Number Information
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NPI Number | 1831329218
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Entity Type | Organization
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Legal Business Name | PREMIERE MEDICAL CENTER OF BURBANK, INC.
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 4418 VINELAND AVE STE 102
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-3457
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Country | US
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Telephone | 818-842-7145
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Fax | 818-842-8202
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Provider Business Mailing Address
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Address Line | 4418 VINELAND AVE STE 102
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-3457
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Country | US
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Telephone | 818-842-7145
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Fax | 818-842-8202
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MICHAEL DAVID MARSH
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Credential | MD
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Telephone | 818-842-7145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4419
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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