Provider Demographics
NPI:1164730412
Name:CAITH, KEVIN C (PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:CAITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:C
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:LOBBY J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-572-4500
Mailing Address - Fax:
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 301
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-572-4500
Practice Address - Fax:734-572-4503
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093370OtherNCCPA CERTIFICATION
MI5315090475OtherMICHIGAN CONTROLLED SUBSTANCE LICENSE
MI5601008033OtherMICHIGAN PA LICENSE
CAMS2262943OtherDEA