Healthcare Provider Details

I. General information

NPI: 1063377265
Provider Name (Legal Business Name): EXCEL FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 GATEWOOD DR BLDG C102
LAKEWOOD RANCH FL
34211-4944
US

IV. Provider business mailing address

11065 GATEWOOD DR BLDG C102
LAKEWOOD RANCH FL
34211-4944
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-8639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JEMAAR GRAHAM
Title or Position: OWNER
Credential: DPM
Phone: 941-404-5946