Provider Demographics
NPI:1245275163
Name:E MICHAEL AGAPOS, MD, PC
Entity type:Organization
Organization Name:E MICHAEL AGAPOS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AGAPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-757-2345
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0231
Mailing Address - Country:US
Mailing Address - Phone:901-757-2345
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:3960 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2504
Practice Address - Country:US
Practice Address - Phone:901-761-4131
Practice Address - Fax:901-761-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013104Medicaid
TN4069219OtherBC/BS PROV ID
MS00123392Medicaid
TNF24922Medicare UPIN
TN3714085Medicaid