Organization
ELITE PROVIDER GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CHANDLER (AUTHORIZED OFFICIAL)
(810) 424-2136
Entity
Organization
Contact information
Practice address
5900 WALDON RD STE A, CLARKSTON, MI 48346-4806
(248) 625-7890
Mailing address
3495 S CENTER RD, BURTON, MI 48519-1455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
06/20/2025
Last updated
09/04/2025
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