Provider Demographics
NPI:1679056972
Name:EXCEL SPORTS MEDICINE INSTITUTE AND ORTHOPEDIC INSTITUTE PLLC
Entity Type:Organization
Organization Name:EXCEL SPORTS MEDICINE INSTITUTE AND ORTHOPEDIC INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TORITSENERE
Authorized Official - Middle Name:BLESSING
Authorized Official - Last Name:ONOSODE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-431-1539
Mailing Address - Street 1:4825 ALLIANCE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4825 ALLIANCE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5504
Practice Address - Country:US
Practice Address - Phone:469-431-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty