Exelsior Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

PA9107461 Issued in FL

Legal business name

EXELSIOR MEDICAL GROUP, INC.

Practice address

951 NE 167TH St
Suite 102
North Miami Beach, FL 33162-3711

Phone

(305) 944-1122

Fax

(305) 944-1133

NPI assigned

Oct 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alexander Tirado, PA-C

Title

President

Phone

(305) 944-1122

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413244800000",
    "number": "1477957967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 NE 167TH ST",
            "address_2": "SUITE 102",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331623711",
            "telephone_number": "305-944-1122",
            "fax_number": "305-944-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 NE 167TH ST",
            "address_2": "SUITE 102",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331623711",
            "telephone_number": "305-944-1122",
            "fax_number": "305-944-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXELSIOR MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-14",
        "last_updated": "2014-10-14",
        "status": "A",
        "authorized_official_last_name": "TIRADO",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-944-1122",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "PA9107461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010736200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA-C",
            "identifier": "PA9107461",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Executive Medical Physics Associates, LLC
• Exelsior Diagnostic Service, Inc.
• Express Vision Care, Inc.
• Eyes Right Opticians and Eye Doctors, Inc.
• Mary Ezem, CRNA
• Mohammed Ezuddin, MD
• Nisreen Shabbir Ezuddin, MD

• Internal Medicine Physician in North Miami Beach, FL
• Providers in North Miami Beach, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.