NPIMap

Individual provider Active NPI

Ralph Wiktor, PA-C

  • Physician Assistant
  • Grand Blanc, MI
National Provider Identifier
1285674044
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003281 Issued in MI
Practice address
10683 S Saginaw St Ste B
Grand Blanc, MI 48439-8127
Phone
(810) 771-4074
NPI assigned
Jun 8, 2006
Last updated
Dec 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601003281 MI
Physician Assistant 363A00000X 5601003281 MI Primary

Addresses

Primary practice location

10683 S Saginaw St Ste B
Grand Blanc, MI 48439-8127

Mailing address

2861 Lake Charnwood Dr
Troy, MI 48098-2120
Phone (313) 434-2439

Other practice location 1

11400 Joseph Campau St
Hamtramck, MI 48212-3041
Phone (313) 366-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040628000922 MI Practitioner - Physician Assistant 7810973153 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Creekside Counseling Group LLCGroup PAC ID 9133521255, 33 clinicians
Modern Psych and Wellness PLLCGroup PAC ID 8729529623, 7 clinicians

Practice addresses (Care Compare)

10801 S Saginaw St
Suite D
Grand Blanc, MI 48439-8126
Phone (810) 771-4074

21415 Goddard Rd
Taylor, MI 48180-4247
Phone (248) 667-8014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601003281MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Psych and Wellness PLLC CurrentSince Dec 22, 2025 Accepting new patients
Back on Track Medical Equipment LLC CurrentSince Dec 22, 2025 Accepting new patients
M.a.Munir MD PC PastSince Jul 23, 2018 Accepting new patients
Family Care Medical Clinic PLLC Medical Past Accepting new patients
Joel a Milliner M D P C Past Accepting new patients
Rhett Enterprises, Inc. PastSince Jan 2, 2015 Accepting new patients
Provider Services Network LLC PastSince Dec 30, 2017 Accepting new patients
Care Solutions Group, LLC PastSince Feb 1, 2021 Accepting new patients
Greenfield and 9 Mile Medical Center PLLC Past Accepting new patients

Locations

21415 Goddard Rd
Taylor, MI 48180
Phone (248) 667-8014

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1285674044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 LAKE CHARNWOOD DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480982120",
            "telephone_number": "313-434-2439",
            "fax_number": "248-250-9566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10683 S SAGINAW ST STE B",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398127",
            "telephone_number": "810-771-4074"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11400 Joseph Campau St",
            "address_purpose": "LOCATION",
            "city": "Hamtramck",
            "state": "MI",
            "postal_code": "482123041",
            "country_code": "US",
            "telephone_number": "313-366-5500",
            "fax_number": "313-366-5505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIKTOR",
        "first_name": "RALPH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003281",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

Verify at the official NPI Registry.