Provider Demographics
NPI:1841478070
Name:APPOLINE MEDICAL CLINIC PC
Entity type:Organization
Organization Name:APPOLINE MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:T
Authorized Official - Last Name:SAWALHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-491-4999
Mailing Address - Street 1:8740 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4043
Mailing Address - Country:US
Mailing Address - Phone:313-491-4999
Mailing Address - Fax:313-491-4939
Practice Address - Street 1:8740 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4043
Practice Address - Country:US
Practice Address - Phone:313-491-4999
Practice Address - Fax:313-491-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS072978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P25900Medicare PIN