Healthcare Provider Details

I. General information

NPI: 1073178232
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP OF MILWAUKEE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 S 27TH ST
FRANKLIN WI
53132-8034
US

IV. Provider business mailing address

PO BOX 4564
SPRINGFIELD IL
62708-4564
US

V. Phone/Fax

Practice location:
  • Phone: 414-574-0253
  • Fax: 414-304-5853
Mailing address:
  • Phone: 941-360-1566
  • Fax: 941-358-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AYMAN ELFAR
Title or Position: MEMBER/MANAGER
Credential: MD
Phone: 941-360-1566