Healthcare Provider Details

I. General information

NPI: 1295982114
Provider Name (Legal Business Name): ATA ATOGHO M.D., FACOG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NW 170TH ST STE 304
NORTH MIAMI BEACH FL
33169-5511
US

IV. Provider business mailing address

100 NW 170TH ST 304
NORTH MIAMI BEACH FL
33169-5513
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-4105
  • Fax: 305-652-3566
Mailing address:
  • Phone: 305-653-4105
  • Fax: 305-652-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME102337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: