Provider Demographics
NPI:1790248805
Name:EXCEL UROLOGY PLLC
Entity Type:Organization
Organization Name:EXCEL UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYICHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:ANUSIONWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-635-0811
Mailing Address - Street 1:6138 PRECINCT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2610
Mailing Address - Country:US
Mailing Address - Phone:214-238-6985
Mailing Address - Fax:
Practice Address - Street 1:6138 PRECINCT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2610
Practice Address - Country:US
Practice Address - Phone:214-238-6985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty