Provider Demographics
NPI:1528342441
Name:ELITE HEALTH OF MICHIGAN
Entity type:Organization
Organization Name:ELITE HEALTH OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:LIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TOCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-802-7743
Mailing Address - Street 1:4820 FOX CRK E
Mailing Address - Street 2:#135
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4946
Mailing Address - Country:US
Mailing Address - Phone:248-802-7743
Mailing Address - Fax:248-650-3751
Practice Address - Street 1:1424 N ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1188
Practice Address - Country:US
Practice Address - Phone:248-650-6100
Practice Address - Fax:248-650-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009839261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service