MEDICARE: APOLLO MEDICAL GROUP OF ILLINOIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1730934597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO MEDICAL GROUP OF ILLINOIS LLC

Provider Business Mailing Address
First Line	:	PO BOX 4324
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62708-4324
Country	:	US
Telephone Number	:	941-725-1198
Fax Number	:

Provider Business Practice Location Address
First Line	:	3034 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3729
Country	:	US
Telephone Number	:	773-497-1961
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	AYMAN ELFAR
Credential	:	MD
Telephone Number	:	941-725-1198

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/25/2024

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