ELITE DERMATOLOGY AND AESTHETIC INSTITUTE LLC NPI 1154735819

NPI Information

  • NPI: 1154735819
  • Provider Name: ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: ELITE MEDICINE AND AESTHETIC INSTITUTE
  • CLIA Number: 10D2098860
  • Address: 1905 CLINT MOORE RD
    SUITE 203
    BOCA RATON, FL
    ZIP 33496
  • Phone: (561) 826-6650

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NPI Details

ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC is a family medicine in Boca Raton, FL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC NPI is 1154735819. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Elite Medicine And Aesthetic Institute.

The provider's business location address is:

1905 CLINT MOORE RD
SUITE 203
BOCA RATON, FL
ZIP 33496-658
Phone: (561) 826-6650
Fax: (561) 826-6649

The provider's authorized official is Fawn Winkelman .
The authorized official title is President and has the following contact phone number (561) 826-6650.

The CLIA number assigned to this NPI record is 10D2098860 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/20/2014 and was last updated on 11/19/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineOS1629FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
111877AOTHERFLORIDAMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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