Healthcare Provider Details

I. General information

NPI: 1992568455
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 WHIPPLE AVE NW
NORTH CANTON OH
44720-7618
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 615-234-8908
  • 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: MEMBER
Credential: MD
Phone: 812-455-7798