=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144565078
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XCEL MED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2012
-----------------------------------------------------
Last Update Date | 12/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2325 POINTE PKWY SUITE 150
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-3294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-688-9028
-----------------------------------------------------
Fax | 317-688-9029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 MADISON ST
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-864-4901
-----------------------------------------------------
Fax | 847-455-1666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ELLY LATINIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-864-4901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BN1400X
-----------------------------------------------------
Taxonomy Name | Nursing Facility Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------