Individual provider Active NPI

Tabitha Kildani, PA

  • Physician Assistant
  • Dearborn, MI
National Provider Identifier
1770788226
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004050 Issued in MI
Practice address
861 Monroe St
Dearborn, MI 48124-2308
Phone
(313) 274-1800
Fax
(313) 277-4011
NPI assigned
Jun 15, 2007
Last updated
Apr 25, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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 5601004050 MI Primary

Addresses

Primary practice location

861 Monroe St
Dearborn, MI 48124-2308

Mailing address

1905 Venice St
Dearborn, MI 48124-4140
Phone (313) 522-0306

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070720000071 MI Practitioner - Physician Assistant 7315048386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

39450 W 12 Mile Rd
Novi, MI 48377-3600
Phone (248) 344-8080

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004050MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Physician Assistant CurrentSince Jan 15, 2019 Accepting new patients
Henry Ford Health System CurrentSince Jan 15, 2019 Accepting new patients
Henry Ford Maplegrove Center Past Accepting new patients

Locations

861 Monroe St
Dearborn, MI 48124
Phone (313) 274-1800

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

Interoperability endpoints

  • Direct secure messaging: tkildani562808@direct.hfhs.org

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366848000000",
    "number": "1770788226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 VENICE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244140",
            "telephone_number": "313-522-0306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 MONROE ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242308",
            "telephone_number": "313-274-1800",
            "fax_number": "313-277-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILDANI",
        "first_name": "TABITHA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-15",
        "last_updated": "2013-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.