Basic Information
Provider Information | |||||||||
NPI: | 1134313711 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | APOLONIO | ||||||||
FirstName: | FERDINAND | ||||||||
MiddleName: | EMMANUEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8672 HOLLIS LN | ||||||||
Address2: |   | ||||||||
City: | BRECKSVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 441412032 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4406673745 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 55 ARCH ST | ||||||||
Address2: | SUITE 3A | ||||||||
City: | AKRON | ||||||||
State: | OH | ||||||||
PostalCode: | 443041423 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3303753584 | ||||||||
FaxNumber: | 3303753730 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/28/2007 | ||||||||
LastUpdateDate: | 08/28/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 57-010111 | OH | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.