MEDICARE: ELITE DERM SERVICES, 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	207ZD0900X	Dermatopathology (Pathology) Physician

General Provider Information

NPI Number	:	1861209298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE DERM SERVICES, PLLC

Provider Business Mailing Address
First Line	:	27131 FULSHEAR BEND DR
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-1231
Country	:	US
Telephone Number	:	281-612-0050
Fax Number	:	281-612-0051

Provider Business Practice Location Address
First Line	:	27131 FULSHEAR BEND DR
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-1231
Country	:	US
Telephone Number	:	281-612-0050
Fax Number	:	281-612-0051

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER RIZK
Credential	:	MD
Telephone Number	:	281-612-0050

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/19/2024

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