Provider Demographics
NPI:1578228300
Name:ELITE HEALTH PLLC
Entity Type:Organization
Organization Name:ELITE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER AND BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ABLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-207-5767
Mailing Address - Street 1:5895 W VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2159
Mailing Address - Country:US
Mailing Address - Phone:313-554-4357
Mailing Address - Fax:313-554-1565
Practice Address - Street 1:5901 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-2180
Practice Address - Country:US
Practice Address - Phone:313-554-4357
Practice Address - Fax:313-554-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-06
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty