MEDICARE: EXCEL FOOT AND ANKLE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1063377265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL FOOT AND ANKLE PLLC

Provider Business Mailing Address
First Line	:	11065 GATEWOOD DR BLDG C102
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34211-4944
Country	:	US
Telephone Number	:
Fax Number	:	941-751-0976

Provider Business Practice Location Address
First Line	:	11065 GATEWOOD DR BLDG C102
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34211-4944
Country	:	US
Telephone Number	:	941-782-8639
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEMAAR GRAHAM
Credential	:	DPM
Telephone Number	:	941-782-8639

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	03/02/2026

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