MEDICARE: PROGRESSIVE MEDICAL GROUP

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	C050258	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W19002	OTHER	CA	GROUP MEDICARE ID NUMBER

General Provider Information

NPI Number	:	1962459735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1215 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2503
Country	:	US
Telephone Number	:	818-553-0800
Fax Number	:	818-553-0804

Provider Business Practice Location Address
First Line	:	1215 S CENTRAL AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-2503
Country	:	US
Telephone Number	:	818-553-0800
Fax Number	:	818-553-0804

Authorized Official
Title or Position	:	CEO
Name	:	DR. KEVORK ARTIN VORPERIAN
Credential	:	MD
Telephone Number	:	818-553-0800

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	08/22/2020

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Directions to “PROGRESSIVE MEDICAL GROUP ” Practice Location

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