Provider Demographics
NPI:1730934597
Name:APOLLO MEDICAL GROUP OF ILLINOIS LLC
Entity type:Organization
Organization Name:APOLLO MEDICAL GROUP OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-725-1198
Mailing Address - Street 1:PO BOX 4324
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-4324
Mailing Address - Country:US
Mailing Address - Phone:941-725-1198
Mailing Address - Fax:
Practice Address - Street 1:3034 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3729
Practice Address - Country:US
Practice Address - Phone:773-497-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty