Provider Demographics
NPI:1144813007
Name:EXCEL MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:EXCEL MEDICAL SUPPLY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-549-7708
Mailing Address - Street 1:30700 TELEGRAPH RD # 2501
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4524
Mailing Address - Country:US
Mailing Address - Phone:248-571-2290
Mailing Address - Fax:248-593-9120
Practice Address - Street 1:30700 TELEGRAPH RD # 2501
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4524
Practice Address - Country:US
Practice Address - Phone:248-571-2290
Practice Address - Fax:248-593-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier