Provider Demographics
NPI:1871826917
Name:BURBANK PREFERRED PROVIDER MEDICAL GROUP, INC
Entity type:Organization
Organization Name:BURBANK PREFERRED PROVIDER MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KROOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-567-6550
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4569
Mailing Address - Country:US
Mailing Address - Phone:818-567-6550
Mailing Address - Fax:818-579-7811
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:STE 300
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4569
Practice Address - Country:US
Practice Address - Phone:818-567-6550
Practice Address - Fax:818-579-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79419207Q00000X
CAG36316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty