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General NPI Number Information
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NPI Number | 1699582593
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Entity Type | Organization
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Legal Business Name | APOLLO MEDICAL GROUP OF MICHIGAN PLLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 3200 W CENTRE AVE STE 101
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City | PORTAGE
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State | MI
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Zip | 49024-4889
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Country | US
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Telephone | 269-323-9905
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2698
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City | SPRINGFIELD
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State | IL
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Zip | 62708-2698
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Country | US
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Telephone | 941-725-1198
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | AYMAN ELFAR
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Credential | MD
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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 |
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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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