Basic Information
| Provider Information | |||||||||
| NPI: | 1215454657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCEL RENAL CARE SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 68698 | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601680698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818534429 | ||||||||
| FaxNumber: | 7732963002 | ||||||||
| Practice Location | |||||||||
| Address1: | 3002 N ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606573012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732963003 | ||||||||
| FaxNumber: | 7732963002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2017 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | SYED SHAH | ||||||||
| AuthorizedOfficialFirstName: | KAREEM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6307489407 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.