Provider Demographics
NPI:1710418934
Name:APOLLO MEDICAL GROUP OF KANKAKEE LLC
Entity Type:Organization
Organization Name:APOLLO MEDICAL GROUP OF KANKAKEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-455-7798
Mailing Address - Street 1:PO BOX 1963
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1963
Mailing Address - Country:US
Mailing Address - Phone:941-360-1566
Mailing Address - Fax:941-358-9818
Practice Address - Street 1:403 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2152
Practice Address - Country:US
Practice Address - Phone:815-928-9999
Practice Address - Fax:815-928-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty