Healthcare Provider Details

I. General information

NPI: 1811203789
Provider Name (Legal Business Name): ELITE HOME PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30108 FORD RD
GARDEN CITY MI
48135-2370
US

IV. Provider business mailing address

30108 FORD RD
GARDEN CITY MI
48135-2370
US

V. Phone/Fax

Practice location:
  • Phone: 734-956-5821
  • Fax:
Mailing address:
  • Phone: 734-956-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301038699
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005435
License Number StateMI

VIII. Authorized Official

Name: MRS. RANIA M BEYDOUN
Title or Position: OWNER
Credential: PA
Phone: 734-956-5821