Individual provider Active NPI

Kenneth M Schmidtke, PA-C

  • Physician Assistant
  • Saint Clair Shores, MI
National Provider Identifier
1174435275
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
23114 Edsel Ford CT
Saint Clair Shores, MI 48080-2502
Phone
(313) 522-1228
NPI assigned
Sep 22, 2026
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MI Primary

Addresses

Primary practice location

23114 Edsel Ford CT
Saint Clair Shores, MI 48080-2502

Mailing address

23114 Edsel Ford CT
Saint Clair Shores, MI 48080-2502
Phone (313) 522-1228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1174435275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23114 EDSEL FORD CT",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802502",
            "telephone_number": "313-522-1228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23114 EDSEL FORD CT",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802502",
            "telephone_number": "313-522-1228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDTKE",
        "first_name": "KENNETH",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.