Provider Demographics
NPI:1922613637
Name:ELITE MEDICAL GRP LLC
Entity Type:Organization
Organization Name:ELITE MEDICAL GRP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:TARIQ
Authorized Official - Last Name:INSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:407-607-0099
Mailing Address - Street 1:280 PATTERSON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6261
Mailing Address - Country:US
Mailing Address - Phone:407-607-0099
Mailing Address - Fax:
Practice Address - Street 1:280 PATTERSON RD STE 3
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6261
Practice Address - Country:US
Practice Address - Phone:407-607-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty