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General NPI Number Information
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NPI Number | 1134477912
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Entity Type | Organization
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Legal Business Name | EXCEL MEDICAL GROUP
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 42928 VERSAILLES
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City | CANTON
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State | MI
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Zip | 48187-2344
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Country | US
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Telephone | 734-414-0754
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Fax | 734-414-0769
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Provider Business Mailing Address
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Address Line | 2718 RIVER RD
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City | MAUMEE
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State | OH
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Zip | 43537-3737
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Country | US
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Telephone | 734-414-0754
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Fax | 734-414-0769
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN RICE
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Credential | MD
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Telephone | 734-414-0754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35067035C
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License Number State | OH
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