Provider Demographics
NPI:1003848623
Name:KILBREATH, ALEESHA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEESHA
Middle Name:
Last Name:KILBREATH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEESHA
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 HURLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5902
Mailing Address - Country:US
Mailing Address - Phone:810-762-7038
Mailing Address - Fax:810-760-0440
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-762-7038
Practice Address - Fax:810-760-0440
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003969363AM0700X, 363AS0400X
MI4601003969363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82310Medicare ID - Type UnspecifiedMEMBER # N82310002
MIP97593Medicare UPIN