Provider Demographics
NPI:1891767281
Name:APOLLO FAMILY HEALTH SERVICES PC
Entity Type:Organization
Organization Name:APOLLO FAMILY HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBHATLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-421-6333
Mailing Address - Street 1:5823 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2459
Mailing Address - Country:US
Mailing Address - Phone:734-421-6333
Mailing Address - Fax:734-421-9954
Practice Address - Street 1:5823 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2459
Practice Address - Country:US
Practice Address - Phone:734-421-6333
Practice Address - Fax:734-421-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110827980-2OtherBLUE CROSS BLUE SHIELD,MI
MI4112248Medicaid
MIG99823Medicare UPIN
MION20400Medicare ID - Type Unspecified