Provider Demographics
NPI:1366554487
Name:EXCEL ORTHOPEDICS, LTD.
Entity type:Organization
Organization Name:EXCEL ORTHOPEDICS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-885-2663
Mailing Address - Street 1:705 S UNIVERSITY AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3071
Mailing Address - Country:US
Mailing Address - Phone:920-885-2663
Mailing Address - Fax:920-885-2466
Practice Address - Street 1:705 S UNIVERSITY AVE
Practice Address - Street 2:STE 150
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3071
Practice Address - Country:US
Practice Address - Phone:920-885-2663
Practice Address - Fax:920-885-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32871500Medicaid
5077130001Medicare NSC
WI000022255Medicare PIN
WI000013190Medicare PIN
WI000016175Medicare PIN