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General NPI Number Information
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NPI Number | 1871138974
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Entity Type | Organization
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Legal Business Name | EXCEL HEART CARE, PLLC
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 1 MEDICAL PKWY STE 103
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City | DALLAS
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State | TX
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Zip | 75234-7830
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Country | US
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Telephone | 214-663-1387
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 MONTEREY DR
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City | FRISCO
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State | TX
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Zip | 75034-4083
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Country | US
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Telephone | 214-663-1387
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SUBBA RAJU KOSURI
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Credential | MD
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Telephone | 214-663-1387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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