Courtney Kiseda

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704307202 Issued in MI

Practice address

50505 Schoenherr Rd Ste 270
Shelby Township, MI 48315-3141

Phone

(586) 323-6058

Fax

(586) 500-8865

NPI assigned

Apr 24, 2020

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

Electronic endpoints 2

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Promed Preferred Mi 2 PLLCGroup PAC ID 0345779369, 9 clinicians

Great Lakes Medicine PLCGroup PAC ID 4880613637, 33 clinicians

Premier Wound Care PLLCGroup PAC ID 6103273719, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Great Lakes Medicine, PLC

  • Hospitalist Physician
  • Shelby Township, MI
  • NPI 1740210517
  Medicare reassignment Care Compare group NPD
• Premier Wound Care PLLC

  • Internal Medicine Physician
  • Shelby Township, MI
  • NPI 1669253894
  Medicare reassignment Care Compare group NPD
• Promed Preferred Mi 2, PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1245049311
  NPD

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

{
    "created_epoch": "1587686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787875200000",
    "number": "1982224465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD STE 270",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153141",
            "telephone_number": "586-323-6058",
            "fax_number": "586-500-8865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD STE 270",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153141",
            "telephone_number": "586-323-6058",
            "fax_number": "586-500-8865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 E Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Ann Arbor",
            "state": "MI",
            "postal_code": "481095000",
            "country_code": "US",
            "telephone_number": "734-936-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISEDA",
        "first_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-24",
        "last_updated": "2026-08-28",
        "certification_date": "2026-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704307202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjrhodes@med.umich.edu",
            "affiliation": "N",
            "address_1": "1500 E Medical Center Dr",
            "city": "Ann Arbor",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481095000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cjrhodes@med.umich.edu",
            "affiliation": "N",
            "address_1": "1500 E Medical Center Dr",
            "city": "Ann Arbor",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481095000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Lynn King, PTA
• Mackenzie Marie King, PA-C
• Kevin Kinney
• Mary Kinzie, MSW LMSW ACSW
• Jennell Kiryakos
• Isabella Kisha
• KJ Business Management LLC
• Meghan Klakulak
• Leah Klauss, RN
• Suzanne Klein-Overmeer

• Nurse Practitioner in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.