Provider Demographics
NPI:1093921561
Name:ELITE MEDICAL ALLIANCE INC
Entity Type:Organization
Organization Name:ELITE MEDICAL ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:KESHVARI-RASTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-365-1114
Mailing Address - Street 1:PO BOX 347273
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33234-7273
Mailing Address - Country:US
Mailing Address - Phone:305-365-1114
Mailing Address - Fax:305-365-1119
Practice Address - Street 1:260 CRANDON BLVD STE 8
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1537
Practice Address - Country:US
Practice Address - Phone:305-365-1114
Practice Address - Fax:305-365-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC763Medicare PIN