KELLY MARIE POLETIS (NPI# 1528317153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528317153 |
| Entity Type | Individual |
| Full Name | KELLY MARIE POLETIS |
| Credential | PA-C |
| Practice Address |
15855 19 Mile Rd Clinton Twp MI 48038 |
| Mailing Address |
1 Ford Pl Ste 2e Detroit MI 48202-3450 |
| Practice Telephone | 5862632113 |
| Mailing Telephone | 3138744806 |
| Mailing Fax Number | 3138761305 |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2018-09-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 5601007695 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085004402 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1725 W Harrison St, Chicago, IL 606123841 | 3127722273 |
| Street Address |
15855 19 MILE RD |
| City | CLINTON TWP |
| State | MI |
| Zip Code | 48038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811991177 | Timothy Peter Boufford | Internal Medicine | 15855 19 Mile Rd, Henry Ford Macomb, Clinton Twp, MI 48038-3504 | 2005-06-02 |
| 1144857400 | Brent Geers | Orthopaedic Surgery | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2020-03-26 |
| 1245867118 | Michael Sochacki | Student in an Organized Health Care Education/Training Program | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2020-03-23 |
| 1184259459 | Christina Lynn James | Nurse Practitioner | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2020-03-07 |
| 1417596396 | Amanda Marie Disanto | Nurse Anesthetist, Certified Registered | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-12-25 |
| 1114566189 | Jeffrey M Kirby | Nurse Anesthetist, Certified Registered | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-12-23 |
| 1164071783 | Ryan Amber Beebe | Nurse Practitioner | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-09-06 |
| 1215590583 | Sharan Mullen | Student in an Organized Health Care Education/Training Program | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-04-22 |
| 1669934873 | Haley Svrcina Lehman | Student in an Organized Health Care Education/Training Program | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-04-05 |
| 1336600311 | Joseph Gerald Lucido | Student in an Organized Health Care Education/Training Program | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2019-03-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447864129 | Raphael Antonio Tramble | Counselor | River Oaks Suites Plaza 42815 Garfield Road, Suite 201, Clinton Township, MI 48038 | 2020-09-01 |
| 1275160384 | Varun C Sankuratri | Obstetrics & Gynecology | 16515 Nineteen Mile Rd, Gme Office: Attention Obgyn PC Kelly Bennet, Clinton Township, MI 48038 | 2020-03-26 |
| 1114563178 | Hopeful Reflections Counseling Center, Pllc | Counselor | 44444 Hayes, Clinton Township, MI 48038 | 2019-11-25 |
| 1588224570 | Karrie Marie Armstrong | Social Worker | 42815 Garfield Rd Macomb Therapy Group, Suite 201, Clinton Twp, MI 48038 | 2019-06-20 |
| 1386201424 | Rx Mart Pharmacy LLC | Pharmacy | 43171 Dalcoma Dr Ste #2, Clinton Twp, MI 48038 | 2019-05-23 |
| 1306314489 | Rx Mart Pharmacy LLC | Pharmacy | 43171 Dalcoma Dr., Suite 2, Clinton Twp, MI 48038 | 2018-11-07 |
| 1730677592 | Najoi Sleiman | Physical Medicine & Rehabilitation | 15855 19-mile Road, Rehab Services, 4th Floor, South Tower, Clinton Twp., MI 48038 | 2018-04-27 |
| 1295230365 | David Michael Ragbeer | Emergency Medicine | Henry Ford Macomb Hospitals, 15855 Nineteen Mile Road, Clinton Township, MI 48038 | 2018-03-29 |
| 1932601317 | Synergy Pharmacy LLC | Pharmacy | 42621 Garfield Rd Ste 101a, Clinton Township, MI 48038 | 2018-03-01 |
| 1689175002 | Melissa Velez Miracle | Speech-Language Pathologist | 38809 Windmill Pointe W, Clinton Twp, MI 48038 | 2018-02-21 |
| Find all providers in zip 48038 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861090730 | Maloree Blayke Perkins | Physician Assistant | 20717 Coventry St, Clinton Twp, MI 48035-1603 | 2020-10-13 |
| 1003174533 | Leeann Wickens | Physician Assistant | 41221 Little Rd, Clinton Twp, MI 48036-1411 | 2012-05-03 |
| 1831478361 | Whitney Marie Wright | Physician Assistant | 43475 Dalcoma Dr., Ste 900, Clinton Twp, MI 48038 | 2011-08-15 |
| 1598906075 | Sunitha Varughese | Physician Assistant | 19821 Woodview Dr, Clinton Twp, MI 48038-4954 | 2009-03-13 |
| 1538644059 | Daniel Allan Elkins | Physician Assistant | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2018-10-01 |
| 1962994442 | Karl Bjorn Ecklund | Physician Assistant | 15945 19 Mile Rd Ste 106, Clinton Twp, MI 48038-1147 | 2018-05-31 |
| 1831627165 | Alyssa Stork | Physician Assistant | 42621 Garfield Rd Ste 108, Clinton Twp, MI 48038-5031 | 2017-05-31 |
| 1215464615 | Erin Migda Morrison | Physician Assistant | 15855 19 Mile Rd, Clinton Twp, MI 48038-3504 | 2017-05-16 |
| 1922497072 | Lauren Ammar Dawley | Physician Assistant | 21550 Harrington St, Ste. A, Clinton Twp, MI 48036-2362 | 2015-01-13 |
| 1093112542 | Holly Alderman | Physician Assistant | 43740 Garfield Rd, Clinton Twp, MI 48038-1122 | 2014-11-28 |
| Find all providers in CLINTON TWP | ||||
| City | CLINTON TWP |
| Zip Code | 48038 |
Please comment or provide details below to improve the information on KELLY MARIE POLETIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.