Active NPI
Susan Marie Fontaine, PA C
- Physician Assistant
- Detroit, MI
National Provider Identifier
1700970530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1577120
- Practice address
- 22101 Moross Rd
Detroit, MI 48236-2148 - Phone
- (313) 343-3670
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1577120 | MI | Primary |
Addresses
Primary practice location
22101 Moross Rd
Detroit, MI 48236-2148
Mailing address
32524 Holden Dr
Warren, MI 48092-3178
Phone (586) 264-8669
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1577120 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1700970530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32524 HOLDEN DR",
"city": "WARREN",
"state": "MI",
"postal_code": "480923178",
"telephone_number": "586-264-8669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22101 MOROSS RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482362148",
"telephone_number": "313-343-3670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTAINE",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "1577120",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.