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General NPI Number Information
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NPI Number | 1396179461
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Entity Type | Organization
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Legal Business Name | APOLLO MEDICAL GROUP LLC
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 1276 N PLAZA DR
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City | ROCKPORT
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State | IN
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Zip | 47635-9028
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Country | US
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Telephone | 812-649-2500
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Fax | 941-358-9818
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Provider Business Mailing Address
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Address Line | PO BOX 4606
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City | SPRINGFIELD
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State | IL
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Zip | 62708-4606
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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 | DIRECTOR OF ADMINISTRATION
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Name | ROBIN VAN SPRUNDEL
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Credential |
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Telephone | 941-725-1198
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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 | IN
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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 | IN
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