Healthcare Provider Details

I. General information

NPI: 1497610026
Provider Name (Legal Business Name): ELITE RENEW MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8786 NW 139TH TER
MIAMI LAKES FL
33018-7378
US

IV. Provider business mailing address

8786 NW 139TH TER
MIAMI LAKES FL
33018-7378
US

V. Phone/Fax

Practice location:
  • Phone: 786-609-2985
  • Fax:
Mailing address:
  • Phone: 786-609-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. NADIM ANDRES TELLEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-504-0711