Provider Demographics
NPI:1245298132
Name:AGAPOS, EMMANUEL MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:MICHAEL
Last Name:AGAPOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0231
Mailing Address - Country:US
Mailing Address - Phone:901-757-0251
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:3960 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2504
Practice Address - Country:US
Practice Address - Phone:901-844-1427
Practice Address - Fax:901-761-4145
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3335420Medicare ID - Type Unspecified
F24922Medicare UPIN