Provider Demographics
NPI:1871500454
Name:EXCEL PEDIATRICS AND FAMILY CARE
Entity Type:Organization
Organization Name:EXCEL PEDIATRICS AND FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA
Authorized Official - Phone:352-394-3929
Mailing Address - Street 1:265 CITRUS TOWER BLVD
Mailing Address - Street 2:102
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1908
Mailing Address - Country:US
Mailing Address - Phone:352-394-3929
Mailing Address - Fax:352-394-6446
Practice Address - Street 1:265 CITRUS TOWER BLVD
Practice Address - Street 2:102
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1908
Practice Address - Country:US
Practice Address - Phone:352-394-3929
Practice Address - Fax:352-394-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
FLME72542261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660212600Medicaid
FL51657YMedicare ID - Type Unspecified
FL660212600Medicaid