Healthcare Provider Details

I. General information

NPI: 1962143883
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF CINCINNATI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 EDEN PARK DR
CINCINNATI OH
45202-6031
US

IV. Provider business mailing address

8437 BELL OAKS DR # 119
NEWBURGH IN
47630-2582
US

V. Phone/Fax

Practice location:
  • Phone: 866-888-8510
  • Fax:
Mailing address:
  • Phone: 866-888-8510
  • 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: MEMBER/MANAGING PARTNER
Credential: MD
Phone: 812-455-7798