Organization Name: | EXCELLENT MEDICAL ASSOCIATES, P.C. |
NPI Number: | 1215223623 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDRES J GALLEGOS (ATTORNEY) |
Mailing Address: | 14489 John Humphrey Dr Suite 1-na Orland Park |
State: | IL US |
Postal Code: | 604622637 |
Phone Number: | 7083641205 |
Fax Number: | |
NPI Enumeration Date: | 06/23/2011 |
NPI Last Update Date: | 06/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |