Healthcare Provider Details

I. General information

NPI: 1700905213
Provider Name (Legal Business Name): LEVON THOMAS OHAODHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MEDICAL CENTER DR B1-380 TC
ANN ARBOR MI
48109-0999
US

IV. Provider business mailing address

211 ARCADE ST
YPSILANTI MI
48197-8106
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-7919
  • Fax: 734-763-9298
Mailing address:
  • Phone: 734-255-9104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51219
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51869-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: