Provider Demographics
NPI:1447029947
Name:ELITE RELIEF MD
Entity type:Organization
Organization Name:ELITE RELIEF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:U
Authorized Official - Last Name:DESOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:754-200-6410
Mailing Address - Street 1:7740 NOVA DR STE B4
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5802
Mailing Address - Country:US
Mailing Address - Phone:754-200-6410
Mailing Address - Fax:754-200-6411
Practice Address - Street 1:7740 NOVA DR STE B4
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5802
Practice Address - Country:US
Practice Address - Phone:754-200-6410
Practice Address - Fax:754-200-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty