MEDICARE: ELITE HEALTHCARE AND WELLNESS GROUP, INC

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	207Q00000X	Family Medicine Physician	OS13806	FL

General Provider Information

NPI Number	:	1871946236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HEALTHCARE AND WELLNESS GROUP, INC

Provider Business Mailing Address
First Line	:	2430 VANDERBILT BEACH RD
Second Line	:	SUITE 108-345
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-631-6529
Fax Number	:	239-631-6720

Provider Business Practice Location Address
First Line	:	2400 VANDERBILT BEACH RD
Second Line	:	SUITE 106
City	:	NAPLES
State	:	FL
Zip	:	34109-2771
Country	:	US
Telephone Number	:	239-631-6529
Fax Number	:	239-631-6720

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JT DEWITT JR.
Credential	:	D.O.
Telephone Number	:	239-631-6529

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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