Provider Demographics
NPI:1295982114
Name:ATOGHO, ATA (MD, FACOG)
Entity type:Individual
Prefix:DR
First Name:ATA
Middle Name:
Last Name:ATOGHO
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 170TH ST
Mailing Address - Street 2:304
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5513
Mailing Address - Country:US
Mailing Address - Phone:305-653-4105
Mailing Address - Fax:305-652-3566
Practice Address - Street 1:100 NW 170TH ST STE 304
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5511
Practice Address - Country:US
Practice Address - Phone:305-653-4105
Practice Address - Fax:305-652-3566
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102337207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000578600Medicaid
FLAP624YMedicare PIN