Provider Demographics
NPI:1275166282
Name:ELITE MEDICINE, AESTHETICS & REJUVENATION PLLC
Entity Type:Organization
Organization Name:ELITE MEDICINE, AESTHETICS & REJUVENATION PLLC
Other - Org Name:LAKE WASHINGTON INTERNAL MEDICINE PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWKY, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:206-858-2617
Mailing Address - Street 1:8015 SE 28TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2910
Mailing Address - Country:US
Mailing Address - Phone:206-898-2416
Mailing Address - Fax:206-466-6278
Practice Address - Street 1:8015 SE 28TH ST STE 310
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2910
Practice Address - Country:US
Practice Address - Phone:206-858-2617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275166282OtherGROUP NPI