Healthcare Provider Details

I. General information

NPI: 1801637293
Provider Name (Legal Business Name): ELITE MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 PINE LAKE RD
WEST BLOOMFIELD MI
48324-1951
US

IV. Provider business mailing address

3210 PINE LAKE RD
WEST BLOOMFIELD MI
48324-1951
US

V. Phone/Fax

Practice location:
  • Phone: 248-974-2511
  • Fax:
Mailing address:
  • Phone: 248-974-2511
  • 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: MR. YOUSIF ISHMAIL
Title or Position: OWNER
Credential: MD
Phone: 248-974-2511