Healthcare Provider Details

I. General information

NPI: 1114783479
Provider Name (Legal Business Name): ELITE WELLNESS INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 04/07/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S CONGRESS AVE STE 105
BOYNTON BEACH FL
33426-7400
US

IV. Provider business mailing address

6615 W BOYNTON BEACH BLVD STE 412
BOYNTON BEACH FL
33437-3526
US

V. Phone/Fax

Practice location:
  • Phone: 561-203-5282
  • Fax: 740-212-8513
Mailing address:
  • Phone: 561-203-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KANDY MORRIS
Title or Position: SVP OF MANAGED CARE
Credential:
Phone: 702-728-0528