MEDICARE: STAR MEDICAL ASSOCIATES, A 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

General Provider Information

NPI Number	:	1952088684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR MEDICAL ASSOCIATES, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	4312 WOODMAN AVE STE 102
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-5523
Country	:	US
Telephone Number	:	310-488-2830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W VERDUGO AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2147
Country	:	US
Telephone Number	:	310-488-2830
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANTHONY CARDILLO
Credential	:	MD
Telephone Number	:	310-488-2830

Provider Enumeration Date	:	07/04/2023
Last Update Date	:	07/04/2023

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