Provider Demographics
NPI:1922044064
Name:EXCEL DIABETIC SERVICES LLC
Entity Type:Organization
Organization Name:EXCEL DIABETIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-891-9992
Mailing Address - Street 1:1035 NE 125TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5820
Mailing Address - Country:US
Mailing Address - Phone:305-891-9992
Mailing Address - Fax:888-999-4890
Practice Address - Street 1:1035 NE 125TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5820
Practice Address - Country:US
Practice Address - Phone:305-891-9992
Practice Address - Fax:888-999-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0D-020332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5170680001Medicare NSC