Excel Physical Medicine and Rehabilitation PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4301108922 Issued in MI

Legal business name

EXCEL PHYSICAL MEDICINE AND REHABILITATION PC

Practice address

6089 W Maple Rd
Suite 250a
West Bloomfield, MI 48322-2286

Phone

(248) 855-4400

Fax

(248) 855-4414

NPI assigned

Feb 7, 2017

Last updated

Sep 27, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Augustus Peter Evangelista, M.D.

Title

Ceo

Phone

(248) 855-4400

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1861930109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7071 ORCHARD LAKE RD",
            "address_2": "SUITE 333",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223613",
            "telephone_number": "248-626-0470",
            "fax_number": "248-626-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6089 W MAPLE RD",
            "address_2": "SUITE 250A",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483222286",
            "telephone_number": "248-855-4400",
            "fax_number": "248-855-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL PHYSICAL MEDICINE AND REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-09-27",
        "status": "A",
        "authorized_official_last_name": "EVANGELISTA",
        "authorized_official_first_name": "AUGUSTUS",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-855-4400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301108922",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MI",
            "license": "4301108922",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; 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.