MEDICARE: TEAM EXCELLENCE HEALTH

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1568932945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM EXCELLENCE HEALTH

Provider Business Mailing Address
First Line	:	1502 NIAGARA ST APT 604
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1182
Country	:	US
Telephone Number	:	716-402-8899
Fax Number	:	716-604-1944

Provider Business Practice Location Address
First Line	:	1502 NIAGARA ST APT 604
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1182
Country	:	US
Telephone Number	:	716-402-8899
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ENAAME L FARRELL
Credential	:	MD
Telephone Number	:	716-402-8899

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	11/28/2018

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Directions to “TEAM EXCELLENCE HEALTH ” Practice Location

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