| Elite Dermatology And Aesthetic Institute, Llc | |
|
1905 Clint Moore Rd Suite 203 Boca Raton FL 33496-2658 | |
| (561) 826-6650 | |
| (561) 826-6649 |
| Full Name | Elite Dermatology And Aesthetic Institute, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1905 Clint Moore Rd, Boca Raton, Florida |
| Authorized Official Name and Position | Fawn Winkelman (PRESIDENT) |
| Authorized Official Contact | 5618266650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Dermatology And Aesthetic Institute, Llc 1905 Clint Moore Rd Suite 203 Boca Raton FL 33496-2658 Ph: (561) 826-6650 | Elite Dermatology And Aesthetic Institute, Llc 1905 Clint Moore Rd Suite 203 Boca Raton FL 33496-2658 Ph: (561) 826-6650 |
| NPI Number | 1154735819 |
|---|---|
| Provider Enumeration Date | 06/20/2014 |
| Last Update Date | 11/19/2015 |
| Medicare PECOS PAC ID | 2062735681 |
|---|---|
| Medicare Enrollment ID | O20150106000832 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154735819 | NPI | - | NPPES |
| 11877A | Other | FL | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OS1629 (Florida) | Primary |
| Provider Name | Fawn J Winkelman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700192796 PECOS PAC ID: 5698098218 Enrollment ID: I20150106000881 |
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