Healthcare Provider Details

I. General information

NPI: 1811240930
Provider Name (Legal Business Name): AGAPE MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34854 MORAVIAN DR APT. 216
STERLING HEIGHTS MI
48312-5491
US

IV. Provider business mailing address

34854 MORAVIAN DR APT. 216
STERLING HEIGHTS MI
48312-5491
US

V. Phone/Fax

Practice location:
  • Phone: 718-404-7016
  • Fax:
Mailing address:
  • Phone: 718-404-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301099522
License Number StateMI

VIII. Authorized Official

Name: DR. RAAFAT B SHEHATA
Title or Position: OWNER
Credential: MD
Phone: 718-404-7016