MEDICARE: ELITE HEALTH OF MICHIGAN

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	261QH0100X	Health Service Clinic/Center	2301009839	MI

General Provider Information

NPI Number	:	1528342441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HEALTH OF MICHIGAN

Provider Business Mailing Address
First Line	:	4820 FOX CRK E
Second Line	:	#135
City	:	CLARKSTON
State	:	MI
Zip	:	48346-4946
Country	:	US
Telephone Number	:	248-802-7743
Fax Number	:	248-650-3751

Provider Business Practice Location Address
First Line	:	1424 N ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1188
Country	:	US
Telephone Number	:	248-650-6100
Fax Number	:	248-650-3751

Authorized Official
Title or Position	:	OWNER OF LLC
Name	:	DR. LIA MARIE TOCCO
Credential	:	D.C.
Telephone Number	:	248-802-7743

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	02/08/2012

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