Provider Demographics
NPI:1821659301
Name:AHO, TOVAH APOLONIA
Entity Type:Individual
Prefix:
First Name:TOVAH
Middle Name:APOLONIA
Last Name:AHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 KNOB HILL DR APT 7
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4571
Mailing Address - Country:US
Mailing Address - Phone:517-353-4362
Mailing Address - Fax:
Practice Address - Street 1:MICHIGAN STATE UNIVERSITY PSYCHIATRIC RESIDENCY
Practice Address - Street 2:965 FEE ROAD, ROOM A233
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-353-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43510454372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry