Provider Demographics
NPI:1356582712
Name:ELITE PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:ELITE PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-496-1075
Mailing Address - Street 1:21097 NE 27TH CT
Mailing Address - Street 2:STE 335
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:STE 335
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1247
Practice Address - Country:US
Practice Address - Phone:305-933-4033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102672207XS0106X, 2082S0099X, 2082S0105X, 208600000X, 2086S0105X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBX032ZMedicare PIN
FL6385630001Medicare NSC
FLBX029AMedicare PIN