Individual provider Active NPI

Magdalena Agnieszka Kotlarz, PA-C

  • Physician Assistant
  • Southfield, MI
National Provider Identifier
1801769906
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601013337 Issued in MI
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 536-2127
NPI assigned
Sep 25, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

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 5601013337 MI Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

13309 Ledwon St
Shelby Township, MI 48315-5337

Other practice location 1

47601 Grand River Ave
Novi, MI 48374-1233
Phone (248) 536-2127

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
I20251008001478 MI Practitioner - Physician Assistant 4688171473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Independent Hospitalist Physicians PLLCGroup PAC ID 3971874090, 61 clinicians

Practice addresses (Care Compare)

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-3000

47601 Grand River Ave
Novi, MI 48374-1233
Phone (248) 465-4100

Hospital & facility affiliations

  • Ascension Providence Hospital, Southfield and Novi Hospital, Southfield, MI, CCN 230019

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5601013337MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Independent Hospitalist Physicians, PLLC CurrentSince Oct 1, 2025 Accepting new patients
Independent Observation Physicians PLLC CurrentSince Oct 1, 2025 Accepting new patients

Locations

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1758758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1801769906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13309 LEDWON ST",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483155337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-536-2127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "47601 Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Novi",
            "state": "MI",
            "postal_code": "483741233",
            "country_code": "US",
            "telephone_number": "248-536-2127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTLARZ",
        "first_name": "MAGDALENA",
        "middle_name": "AGNIESZKA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601013337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.