Provider Demographics
NPI:1063972925
Name:EXCELCARE MEDICAL PRACTICE
Entity type:Organization
Organization Name:EXCELCARE MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHENTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-246-7242
Mailing Address - Street 1:1027 W CALYPSO CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6769
Mailing Address - Country:US
Mailing Address - Phone:480-935-8855
Mailing Address - Fax:855-450-1054
Practice Address - Street 1:1027 W CALYPSO CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6769
Practice Address - Country:US
Practice Address - Phone:651-246-7242
Practice Address - Fax:855-450-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty