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Contact Information

KELLY M POLETIS, PA-C
15855 19 MILE RD
CILNTON TOWNSHIP, MI48038
 Phone: 586-263-2113
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KELLY M POLETIS · (Female)

NPI # 1528317153
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 08/29/2012
Last updated 09/04/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 085004402
  • MI License # 5601007695
Hospital affiliation(s)
  • HENRY FORD HOSPITAL - (Acute Care)
    2799 W GRAND BLVD
    DETROIT, MI 48202
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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