Provider Demographics
NPI:1992202758
Name:ELITEMD INC
Entity Type:Organization
Organization Name:ELITEMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-224-2707
Mailing Address - Street 1:2960 NE 207TH ST UNIT 1108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1455
Mailing Address - Country:US
Mailing Address - Phone:305-224-2707
Mailing Address - Fax:844-867-3298
Practice Address - Street 1:2960 NE 207TH ST UNIT 1108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1455
Practice Address - Country:US
Practice Address - Phone:305-224-2707
Practice Address - Fax:844-867-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXS7014626OtherSUBOXONE/METHADONE
1083979066OtherNPI