Provider Demographics
NPI:1811240930
Name:AGAPE MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:AGAPE MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-404-7016
Mailing Address - Street 1:34854 MORAVIAN DR
Mailing Address - Street 2:APT. 216
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5491
Mailing Address - Country:US
Mailing Address - Phone:718-404-7016
Mailing Address - Fax:
Practice Address - Street 1:34854 MORAVIAN DR
Practice Address - Street 2:APT. 216
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5491
Practice Address - Country:US
Practice Address - Phone:718-404-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099522208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty