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General NPI Number Information
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NPI Number | 1073178232
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Entity Type | Organization
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Legal Business Name | APOLLO MEDICAL GROUP OF MILWAUKEE SC
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 6495 S 27TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-8034
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Country | US
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Telephone | 414-574-0253
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Fax | 414-304-5853
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Provider Business Mailing Address
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Address Line | PO BOX 4564
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City | SPRINGFIELD
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State | IL
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Zip | 62708-4564
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Country | US
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Telephone | 941-360-1566
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Fax | 941-358-9818
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | AYMAN ELFAR
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Credential | MD
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Telephone | 941-360-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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