Provider Demographics
NPI:1477767218
Name:ATKO, AGATHA KARIN (DO)
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:KARIN
Last Name:ATKO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 ISLAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130
Mailing Address - Country:US
Mailing Address - Phone:734-426-3582
Mailing Address - Fax:
Practice Address - Street 1:3606 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9049
Practice Address - Country:US
Practice Address - Phone:734-929-9450
Practice Address - Fax:734-929-9451
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97484Medicare UPIN