Healthcare Provider Details

I. General information

NPI: 1699582593
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF MICHIGAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W CENTRE AVE STE 101
PORTAGE MI
49024-4889
US

IV. Provider business mailing address

PO BOX 2698
SPRINGFIELD IL
62708-2698
US

V. Phone/Fax

Practice location:
  • Phone: 269-323-9905
  • Fax:
Mailing address:
  • Phone: 941-725-1198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AYMAN ELFAR
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 941-725-1198