Healthcare Provider Details

I. General information

NPI: 1477295434
Provider Name (Legal Business Name): ELITE SPINE AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 NW 70TH AVE STE 200
PLANTATION FL
33317-7578
US

IV. Provider business mailing address

499 NW 70TH AVE STE 200
PLANTATION FL
33317-7578
US

V. Phone/Fax

Practice location:
  • Phone: 954-223-5483
  • Fax: 954-223-5484
Mailing address:
  • Phone: 954-223-5483
  • Fax: 954-223-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAHANGIR ASGHAR
Title or Position: SOLE PROPRIETOR
Credential: MD
Phone: 954-223-5483