Provider Demographics
NPI:1255131488
Name:ELYSIAN LUXURY MEDSPA & WELLNESS LLP
Entity type:Organization
Organization Name:ELYSIAN LUXURY MEDSPA & WELLNESS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARAMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-434-3259
Mailing Address - Street 1:2462 BROOKLYN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-3819
Mailing Address - Country:US
Mailing Address - Phone:816-300-3386
Mailing Address - Fax:
Practice Address - Street 1:2462 BROOKLYN AVE FL 2
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-3819
Practice Address - Country:US
Practice Address - Phone:816-300-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty