Provider Demographics
NPI:1356665350
Name:APOLLO ANESTHESIA, PA
Entity Type:Organization
Organization Name:APOLLO ANESTHESIA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-726-9393
Mailing Address - Street 1:375 S WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1135
Mailing Address - Country:US
Mailing Address - Phone:321-726-9393
Mailing Address - Fax:321-726-9395
Practice Address - Street 1:375 S WICKHAM RD
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1135
Practice Address - Country:US
Practice Address - Phone:321-726-9393
Practice Address - Fax:321-726-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty