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General NPI Number Information
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NPI Number | 1720342397
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Entity Type | Organization
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Legal Business Name | EXCEL CLINIC LLC
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 1480 GRANDVIEW AVE
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City | COLUMBUS
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State | OH
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Zip | 43212
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Country | US
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Telephone | 614-486-9461
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Fax |
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Provider Business Mailing Address
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Address Line | 5340 GORDON WAY
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City | DUBLIN
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State | OH
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Zip | 43017
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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 | MAZHAR HUSSAIN
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Credential | M.D
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Telephone | 614-203-0281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN-198389
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35075884
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License Number State | OH
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