Healthcare Provider Details

I. General information

NPI: 1639226830
Provider Name (Legal Business Name): ELITE MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N DIXIE HWY SUITE 127
BOCA RATON FL
33432-1850
US

IV. Provider business mailing address

1776 N PINE ISLAND RD SUITE 101
PLANTATION FL
33322-5233
US

V. Phone/Fax

Practice location:
  • Phone: 561-447-9360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number6230
License Number StateFL

VIII. Authorized Official

Name: VIVIAN KAPLAN
Title or Position: PRESIDENT
Credential: R.N., B.S.
Phone: 954-581-8700