Provider Demographics
NPI:1639226830
Name:ELITE MD, INC.
Entity Type:Organization
Organization Name:ELITE MD, INC.
Other - Org Name:MD AT HOME, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:954-581-8700
Mailing Address - Street 1:1776 N PINE ISLAND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 N DIXIE HWY
Practice Address - Street 2:SUITE 127
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1850
Practice Address - Country:US
Practice Address - Phone:561-447-9360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6230261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD34262Medicare UPIN
FLK7341Medicare ID - Type Unspecified