Organization
EXCELL DIABETIC SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE JOHN HOLMES (OWNER)
(248) 351-0622
Entity
Organization
Contact information
Practice address
24901 NORTHWESTERN HWY, SUITE 104, SOUTHFIELD, MI 48075-2203
(248) 351-0622
(248) 479-1929
Mailing address
24901 NORTHWESTERN HWY, SUITE 104, SOUTHFIELD, MI 48075-2203
(248) 351-0622
(248) 479-1929
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540F319370
BLUE CROSS BLUE SHEILD
MI
Enumeration date
07/06/2006
Last updated
11/08/2010
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