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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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