Healthcare Provider Details

I. General information

NPI: 1689319469
Provider Name (Legal Business Name): EXCEL IMMEDIATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 W CERMAK RD
WESTCHESTER IL
60154-5250
US

IV. Provider business mailing address

10540 W CERMAK RD
WESTCHESTER IL
60154-5250
US

V. Phone/Fax

Practice location:
  • Phone: 312-838-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EXCEL CARE
Title or Position: NP
Credential: NP
Phone: 312-838-7000