MEDICARE: ELITE INTERNAL MEDICINE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01034369A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528228301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE INTERNAL MEDICINE PC

Provider Business Mailing Address
First Line	:	PO BOX 438
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46308-0438
Country	:	US
Telephone Number	:	219-769-3550
Fax Number	:	219-769-2642

Provider Business Practice Location Address
First Line	:	1242 SURREY CT
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-5239
Country	:	US
Telephone Number	:	219-769-3550
Fax Number	:	219-769-2642

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. RAENETTE NAPIER
Credential	:
Telephone Number	:	219-769-3550

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	12/05/2012

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