Basic Information
| Provider Information | |||||||||
| NPI: | 1942621784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GI EXCELLENCE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 E ELDER ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FALLBROOK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920283083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516522252 | ||||||||
| FaxNumber: | 9516523173 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 E ELDER ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FALLBROOK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920283083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516522252 | ||||||||
| FaxNumber: | 9516523173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2013 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHAKRABARTY | ||||||||
| AuthorizedOfficialFirstName: | INDRANEEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9516522252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.