Kelly Marie Poletis, PA-C
Physician Assistant in Clinton Twp, MI. Individual provider (NPI-1).
NPI number1528317153
StatusActive
Last updated in NPPESSep 4, 2018
Details
- NPI
- 1528317153
- Entity type
- Individual (NPI-1)
- Name
- Kelly Marie Poletis
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 29, 2012
- Last updated
- Sep 4, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 5601007695 | MI | Yes |
| 363A00000X | Physician Assistant | – | – | |
| 363AS0400X | Physician Assistant, Surgical | 085004402 | IL |
Practice location
15855 19 Mile RdClinton Twp, MI 48038
Phone 586-263-2113
Mailing address
1 Ford Pl Ste 2eDetroit, MI 48202-3450
Phone 313-874-4806 · Fax 313-876-1305
Other practice locations
1725 W Harrison St
Chicago, IL 60612-3841
Chicago, IL 60612-3841
Phone 312-772-2273
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All 33 Physician Assistant providers in Clinton Twp · All 1,235 providers in Clinton Twp
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