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General NPI Number Information
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NPI Number | 1215517651
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Entity Type | Organization
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Legal Business Name | I M ELITE
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1101 W UNIVERSITY DR
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City | ROCHESTER
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State | MI
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Zip | 48307-1863
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Country | US
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Telephone | 248-652-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6963 LEXINGTON DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2966
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Country | US
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Telephone | 313-213-4660
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Fax |
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Authorized Official
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Title or Position | DR
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Name | VERONICA MARIA-MOLINA TORRES
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Credential | MD
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Telephone | 313-213-4660
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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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