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General NPI Number Information
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NPI Number | 1023520681
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 50 MAIN ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1231
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Country | US
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Telephone | 616-268-9931
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MAIN ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1231
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Country | US
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Telephone | 616-268-9931
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHANAE BARTLETT
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Credential |
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Telephone | 248-388-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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