MEDICARE: EXCELLENCE CARE CLINIC MD PA

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1932859212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE CARE CLINIC MD PA

Provider Business Mailing Address
First Line	:	PO BOX 540088
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77254-0088
Country	:	US
Telephone Number	:	713-850-1190
Fax Number	:

Provider Business Practice Location Address
First Line	:	19701 KINGWOOD DR
Second Line	:	BUILDING 9
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3775
Country	:	US
Telephone Number	:	304-435-7573
Fax Number	:	832-516-6184

Authorized Official
Title or Position	:	OWNER
Name	:	RIZWAN ALI
Credential	:	MD
Telephone Number	:	832-516-6184

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/20/2025

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