Provider Demographics
NPI:1205450137
Name:EXCEL MIDWEST HEALTHCARE SC
Entity type:Organization
Organization Name:EXCEL MIDWEST HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BINITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-693-0882
Mailing Address - Street 1:2500 W HIGGINS RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2050
Mailing Address - Country:US
Mailing Address - Phone:847-693-0882
Mailing Address - Fax:949-437-3069
Practice Address - Street 1:2500 W HIGGINS RD STE 1120
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2050
Practice Address - Country:US
Practice Address - Phone:847-693-0882
Practice Address - Fax:949-437-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134360Medicaid
IL1487941944OtherNPI