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General NPI Number Information
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NPI Number | 1215373675
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Entity Type | Organization
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Legal Business Name | EXCELLON CORP
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 8015 TURKEY LAKE RD STE 300
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City | ORLANDO
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State | FL
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Zip | 32819-7383
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Country | US
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Telephone | 407-334-4359
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Fax |
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Provider Business Mailing Address
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Address Line | 7557 W SAND LAKE RD # 167
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City | ORLANDO
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State | FL
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Zip | 32819-5109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID CHEESMAN
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Credential | D.O.
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Telephone | 321-354-5250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01054637A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS4187
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License Number State | FL
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