Healthcare Provider Details

I. General information

NPI: 1922613637
Provider Name (Legal Business Name): ELITE MEDICAL GRP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

IV. Provider business mailing address

280 PATTERSON RD STE 3
HAINES CITY FL
33844-6261
US

V. Phone/Fax

Practice location:
  • Phone: 407-607-0099
  • Fax:
Mailing address:
  • Phone: 407-607-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMED TARIQ INSHAN
Title or Position: DC
Credential: DC
Phone: 407-607-0099