Organization
ELITE DERMATOLOGY AND AESTHETIC INSTITUTE, LLC
Active
Other names
ELITE MEDICINE AND AESTHETIC INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
FAWN WINKELMAN DO (PRESIDENT)
(561) 826-6650
Entity
Organization
Contact information
Practice address
1905 CLINT MOORE RD, SUITE 203, BOCA RATON, FL 33496-2658
(561) 826-6650
(561) 826-6649
Mailing address
1905 CLINT MOORE RD, SUITE 203, BOCA RATON, FL 33496-2658
(561) 826-6650
(561) 826-6649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS1629
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11877A
MEDICARE PTAN
FL
Enumeration date
06/20/2014
Last updated
11/19/2015
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