MEDICARE: PREMIERE MEDICAL CENTER OF BURBANK, 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	207Q00000X	Family Medicine Physician
2	213E00000X	Podiatrist	E4419	CA
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1831329218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIERE MEDICAL CENTER OF BURBANK, INC.

Provider Business Mailing Address
First Line	:	4418 VINELAND AVE STE 102
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-3457
Country	:	US
Telephone Number	:	818-842-7145
Fax Number	:	818-842-8202

Provider Business Practice Location Address
First Line	:	4418 VINELAND AVE STE 102
Second Line	:
City	:	TOLUCA LAKE
State	:	CA
Zip	:	91602-3457
Country	:	US
Telephone Number	:	818-842-7145
Fax Number	:	818-842-8202

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. MICHAEL DAVID MARSH
Credential	:	MD
Telephone Number	:	818-842-7145

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	10/26/2018

Similar Medicare Providers

1487584793 — ALLEN GARCIA BORDMAN FNP-C
Practice Location Address:

4418 VINELAND AVE # 102
TOLUCA LAKE, CA
91602-3457

Practice Phone: 818-842-7145
Practice Fax:

1457394694 — ELEANOR ANDREA WALLEN D.P.M.
Practice Location Address:

4418 VINELAND AVE , SUITE 215
TOLUCA LAKE, CA
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Practice Phone: 818-980-3383
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1619992047 — MR. MICHAEL D. MARSH M.D.
Practice Location Address:

4418 VINELAND AVE STE 102
TOLUCA LAKE, CA
91602-3457

Practice Phone: 818-842-7145
Practice Fax: 818-842-8279

1831298736 — MINH Q MACH M.D.
Practice Location Address:

4418 VINELAND AVE STE 102
TOLUCA LAKE, CA
91602-3457

Practice Phone: 818-239-0288
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1336299361 — DR. LAWRENCE H. ZABNER DMD
Practice Location Address:

4418 VINELAND AVE , SUITE 224
TOLUCA LAKE, CA
91602-3457

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Practice Fax: 818-766-7645

1538362322 — DR. JAMES WILLIAM FORMAKER D.D.S.
Practice Location Address:

4418 VINELAND AVE , SUITE 224
TOLUCA LAKE, CA
91602-3457

Practice Phone: 818-508-5707
Practice Fax: 818-766-7645

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