| Elite Provider Group PC | |
|
5900 Waldon Rd Ste A Clarkston MI 48346-4806 | |
| (248) 625-7890 | |
| Not Available |
| Full Name | Elite Provider Group PC |
|---|---|
| Speciality | Family Medicine |
| Location | 5900 Waldon Rd Ste A, Clarkston, Michigan |
| Authorized Official Name and Position | Crystal Chandler (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 8104242136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Provider Group PC 3495 S Center Rd Burton MI 48519-1455 | Elite Provider Group PC 5900 Waldon Rd Ste A Clarkston MI 48346-4806 Ph: (248) 625-7890 |
| NPI Number | 1093602229 |
|---|---|
| Provider Enumeration Date | 06/20/2025 |
| Last Update Date | 09/04/2025 |
| Certification Date | 09/04/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093602229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
| 208000000X | Pediatrics | () | Secondary |
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