Provider Demographics
NPI:1700397700
Name:APOLLO PAIN CARE LLC
Entity Type:Organization
Organization Name:APOLLO PAIN CARE LLC
Other - Org Name:APOLLO PAIN CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PADMAJA
Authorized Official - Middle Name:RANI
Authorized Official - Last Name:YATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-780-1800
Mailing Address - Street 1:14601 SW 29TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4714
Mailing Address - Country:US
Mailing Address - Phone:786-780-1800
Mailing Address - Fax:786-780-2500
Practice Address - Street 1:14601 SW 29TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4714
Practice Address - Country:US
Practice Address - Phone:786-780-1800
Practice Address - Fax:786-780-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA9NN7OtherBCBS