Provider Demographics
NPI:1700335783
Name:EXCELICARE MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:EXCELICARE MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:U
Authorized Official - Last Name:EDOKPAYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-492-8519
Mailing Address - Street 1:14831 JACKSON SAWMILL LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14831 JACKSON SAWMILL LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2086
Practice Address - Country:US
Practice Address - Phone:202-492-8519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3145208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty