| Excelsior Medical Health Center Llc | |
|
18441 Nw 2nd Ave Ste 103 Miami Gardens FL 33169-4517 | |
| (305) 650-1158 | |
| Not Available |
| Full Name | Excelsior Medical Health Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 18441 Nw 2nd Ave Ste 103, Miami Gardens, Florida |
| Authorized Official Name and Position | Geralda Phanor Fleuranvil (CEO) |
| Authorized Official Contact | 7865649438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Excelsior Medical Health Center Llc 1441 Nw 204th St Miami FL 33169-2452 Ph: (786) 564-9438 | Excelsior Medical Health Center Llc 18441 Nw 2nd Ave Ste 103 Miami Gardens FL 33169-4517 Ph: (305) 650-1158 |
| NPI Number | 1710485255 |
|---|---|
| Provider Enumeration Date | 01/30/2018 |
| Last Update Date | 11/09/2021 |
| Medicare PECOS PAC ID | 6204182504 |
|---|---|
| Medicare Enrollment ID | O20180628001909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710485255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | PA9104039 (Florida) | Secondary |
| Provider Name | Ernst B Michel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619961091 PECOS PAC ID: 5496751752 Enrollment ID: I20061010000054 |
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