Melanie Elaine Ilitch, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601006054 Issued in MI

Practice address

36800 Woodward Ave Ste 210
Bloomfield Hills, MI 48304-0917

Phone

(248) 543-3566

NPI assigned

Jul 18, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Melanie Elaine Grove Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Oakland Lifestyle Medicine-PLLC

  • General Practice Physician
  • Bloomfield Hills, MI
  • NPI 1962129544
  Medicare reassignment

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1497043970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36800 WOODWARD AVE STE 210",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483040917",
            "telephone_number": "248-543-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36800 WOODWARD AVE STE 210",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483040917",
            "telephone_number": "248-543-3566"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 W 13 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736712",
            "country_code": "US",
            "telephone_number": "248-898-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILITCH",
        "first_name": "MELANIE",
        "middle_name": "ELAINE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-18",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "GROVE",
            "middle_name": "ELAINE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Wayne Hyde, PH.D
• Craig Hysni, M.D.
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• Iha Olma Specialty Service LLC
• Radu Gabriel Iliescu, MD
• Luise Ann Illuminati, M.D.
• Imad Mansoor MD, PC
• Ramaiz Imran
• Independence House, LLC
• Inspire Home Care

• Physician Assistant in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.