Provider Demographics
NPI:1659684082
Name:KIRONDE, APOLLO GULEMYE
Entity Type:Individual
Prefix:
First Name:APOLLO
Middle Name:GULEMYE
Last Name:KIRONDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARKET ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1125
Mailing Address - Country:US
Mailing Address - Phone:781-715-5369
Mailing Address - Fax:
Practice Address - Street 1:112 MARKET ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1125
Practice Address - Country:US
Practice Address - Phone:781-715-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker