Provider Demographics
NPI:1801637293
Name:ELITE MEDICAL GROUP PC
Entity type:Organization
Organization Name:ELITE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUSIF
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-974-2511
Mailing Address - Street 1:3210 PINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1951
Mailing Address - Country:US
Mailing Address - Phone:248-974-2511
Mailing Address - Fax:
Practice Address - Street 1:3210 PINE LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1951
Practice Address - Country:US
Practice Address - Phone:248-974-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty