MEDICARE: ELITE FAMILY HEALTH P.C.

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	207Q00000X	Family Medicine Physician	01059202A	IN

General Provider Information

NPI Number	:	1669603544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE FAMILY HEALTH P.C.

Provider Business Mailing Address
First Line	:	916 E MAIN STREET
Second Line	:	SUITE 100
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1533
Country	:	US
Telephone Number	:	317-889-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	916 E MAIN ST
Second Line	:	SUITE 100
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1533
Country	:	US
Telephone Number	:	317-889-0900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUNU GEORGE
Credential	:
Telephone Number	:	317-889-0900

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	09/12/2012

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