Organization
EXCEL PHYSICAL MEDICINE AND REHABILITATION PC
Active
Organization
EXCEL PHYSICAL MEDICINE AND REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUSTUS PETER EVANGELISTA M.D. (CEO)
(248) 855-4400
Entity
Organization
Contact information
Practice address
6089 W MAPLE RD, SUITE 250A, WEST BLOOMFIELD, MI 48322-2286
(248) 855-4400
(248) 855-4414
Mailing address
7071 ORCHARD LAKE RD, SUITE 333, WEST BLOOMFIELD, MI 48322-3613
(248) 626-0470
(248) 626-0221
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301108922
MI
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
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