Provider Demographics
NPI:1588025266
Name:ELITE DOC FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:ELITE DOC FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZMUDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-446-3200
Mailing Address - Street 1:17200 STATE HIGHWAY 249
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1185
Mailing Address - Country:US
Mailing Address - Phone:832-446-3200
Mailing Address - Fax:832-446-3108
Practice Address - Street 1:17200 STATE HIGHWAY 249
Practice Address - Street 2:SUITE 100-A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1185
Practice Address - Country:US
Practice Address - Phone:832-446-3200
Practice Address - Fax:832-446-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB2326Medicare UPIN