Provider Demographics
NPI:1558706119
Name:EXCEL PHYSICIANS GROUP PLLC
Entity Type:Organization
Organization Name:EXCEL PHYSICIANS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-641-8578
Mailing Address - Street 1:4100 HERITAGE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5714
Mailing Address - Country:US
Mailing Address - Phone:817-283-1112
Mailing Address - Fax:817-283-1116
Practice Address - Street 1:4100 HERITAGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5714
Practice Address - Country:US
Practice Address - Phone:817-283-1112
Practice Address - Fax:817-283-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty