Provider Demographics
NPI:1427096197
Name:SILVERCARE MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SILVERCARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-613-2414
Mailing Address - Street 1:8306 WILSHIRE BLVD
Mailing Address - Street 2:#501
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2382
Mailing Address - Country:US
Mailing Address - Phone:805-494-8430
Mailing Address - Fax:805-494-8379
Practice Address - Street 1:45 ERBES RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-5802
Practice Address - Country:US
Practice Address - Phone:805-494-8430
Practice Address - Fax:805-494-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP32158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP32158OtherFICTITIOUS NAME PERMIT
CA01904OtherCITY OF THOUSAND OAKS ID
CAFNP32158OtherFICTITIOUS NAME PERMIT