Provider Demographics
NPI:1619201563
Name:PLACIDO, KATHERINE APRIL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:APRIL
Last Name:PLACIDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:30055 NORTHWESTERN HWY STE L-30
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3211
Mailing Address - Country:US
Mailing Address - Phone:248-865-4238
Mailing Address - Fax:248-865-4237
Practice Address - Street 1:30055 NORTHWESTERN HWY STE L-30
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3211
Practice Address - Country:US
Practice Address - Phone:248-865-4238
Practice Address - Fax:248-865-4237
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4517363A00000X
MI5601009701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ466387Medicaid
AZZ134262Medicare PIN