MEDICARE: ELITE INTEGRATIVE GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202D00000X	Integrative Medicine Physician
2	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1003771833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE INTEGRATIVE GROUP PLLC

Provider Business Mailing Address
First Line	:	5422 W THUNDERBIRD RD # 202
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	646-752-4685
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 W THUNDERBIRD RD # 202
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-4700
Country	:	US
Telephone Number	:	646-752-4685
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELA SUYUNOVA
Credential	:
Telephone Number	:	646-752-4685

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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