Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Domonique Bazile

Individual provider Physician Assistant · NPI 1659140655

Domonique Bazile is a Physician Assistant in Detroit, Michigan. Qualified in 2024, 2 years ago. Registered with an NPI since 2024.

Years since qualifying
2
In the registry since
2024
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

18463 Livernois Ave
Detroit, MI 48221-2254
Phone: (313) 369-1500
Fax: (248) 336-9137
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1659140655
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 1, 2024
Last updated in NPPESSeptember 17, 2025
Certification dateSeptember 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Detroit