MEDICARE: GI EXCELLENCE INC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1942621784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GI EXCELLENCE INC

Provider Business Mailing Address
First Line	:	521 E ELDER ST
Second Line	:	SUITE 206
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3083
Country	:	US
Telephone Number	:	951-652-2252
Fax Number	:	951-652-3173

Provider Business Practice Location Address
First Line	:	521 E ELDER ST
Second Line	:	SUITE 206
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3083
Country	:	US
Telephone Number	:	951-652-2252
Fax Number	:	951-652-3173

Authorized Official
Title or Position	:	CEO
Name	:	INDRANEEL CHAKRABARTY
Credential	:	MD
Telephone Number	:	951-652-2252

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	12/26/2013

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