Provider Demographics
NPI:1871138974
Name:EXCEL HEART CARE, PLLC
Entity type:Organization
Organization Name:EXCEL HEART CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBA RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-663-1387
Mailing Address - Street 1:4901 MONTEREY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4083
Mailing Address - Country:US
Mailing Address - Phone:214-663-1387
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PKWY STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7830
Practice Address - Country:US
Practice Address - Phone:214-663-1387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044799706Medicaid