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General NPI Number Information
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NPI Number | 1114783479
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Entity Type | Organization
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Legal Business Name | ELITE WELLNESS INTERNAL MEDICINE INC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 04/07/2024
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Provider Practice Location Address
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Address Line | 2300 S CONGRESS AVE STE 105
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-7400
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Country | US
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Telephone | 561-203-5282
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Fax | 740-212-8513
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Provider Business Mailing Address
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Address Line | 6615 W BOYNTON BEACH BLVD STE 412
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3526
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Country | US
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Telephone | 561-203-5282
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Fax |
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Authorized Official
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Title or Position | SVP OF MANAGED CARE
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Name | KANDY MORRIS
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Credential |
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Telephone | 702-728-0528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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