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
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