Provider Demographics
NPI:1407569411
Name:ELITE SURGICAL SPECIALTIES, LLC
Entity Type:Organization
Organization Name:ELITE SURGICAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERVEUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-603-6167
Mailing Address - Street 1:4941 W SAMPLE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3692
Mailing Address - Country:US
Mailing Address - Phone:516-603-6167
Mailing Address - Fax:
Practice Address - Street 1:6260 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5129
Practice Address - Country:US
Practice Address - Phone:954-494-5530
Practice Address - Fax:954-514-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty