# EXCEL PHYSICAL MEDICINE AND REHABILITATION PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861930109
- **Authorized official:** DR. AUGUSTUS PETER EVANGELISTA M.D. (CEO)
- **Authorized official phone:** (248) 855-4400

## Contact information

- **Practice address:** 6089 W MAPLE RD, SUITE 250A, WEST BLOOMFIELD, MI 48322-2286
- **Practice address phone:** (248) 855-4400
- **Practice address fax:** (248) 855-4414
- **Mailing address:** 7071 ORCHARD LAKE RD, SUITE 333, WEST BLOOMFIELD, MI 48322-3613
- **Mailing address phone:** (248) 626-0470
- **Mailing address fax:** (248) 626-0221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 4301108922 | MI | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 4301108922 | MI | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | MI | — |

## Other

- **Enumeration date:** 02/07/2017
- **Last updated:** 09/27/2017