Organization
ELITE RENEW MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NADIM ANDRES TELLEZ (PRESIDENT)
(305) 504-0711
Entity
Organization
Contact information
Practice address
8786 NW 139TH TER, MIAMI LAKES, FL 33018-7378
(786) 609-2985
Mailing address
8786 NW 139TH TER, MIAMI LAKES, FL 33018-7378
(786) 609-2985
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/16/2025
Last updated
12/16/2025
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