Provider Demographics
NPI:1326037193
Name:FAMILY CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:FAMILY CARE MEDICAL GROUP
Other - Org Name:FAMILY CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRONIJEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-663-3926
Mailing Address - Street 1:17615 MORO RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-8541
Mailing Address - Country:US
Mailing Address - Phone:831-663-3926
Mailing Address - Fax:831-663-0605
Practice Address - Street 1:17615 MORO RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-8541
Practice Address - Country:US
Practice Address - Phone:831-663-3926
Practice Address - Fax:831-663-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ9321ZMedicare ID - Type Unspecified