Organization
ELITE INTERNAL MEDICINE
Active
Organization
ELITE INTERNAL MEDICINE
Active
Other names
Prospect Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TINA YUAN MD (OWNER)
(502) 713-1332
Entity
Organization
Contact information
Practice address
9537 US HIGHWAY 42, PROSPECT, KY 40059-9301
(502) 713-1332
(502) 713-1218
Mailing address
PO BOX 319, PROSPECT, KY 40059-0319
(502) 713-1332
(502) 713-1218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50091760
PASSPORT HEALTH PLAN
KY
Enumeration date
05/12/2015
Last updated
05/06/2022
Update your record
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