Provider Demographics
NPI:1699164699
Name:ELITE FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:ELITE FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAWAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-259-1183
Mailing Address - Street 1:1512 HAMLET DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33200 DEQUINDRE RD
Practice Address - Street 2:SUIT 200
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5967
Practice Address - Country:US
Practice Address - Phone:586-977-0200
Practice Address - Fax:586-977-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083265261QP2300X
MI4301088431261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care