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

Kathryn Marie Poulos

Individual provider Physician Assistant · NPI 1083988323

Kathryn Marie Poulos is a Physician Assistant in Plymouth, Michigan. Qualified in 2011, 15 years ago. Practices with Park Family Health Care PC, a 20-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
15
Licensed in
MI
In the registry since
2012
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Practice location Address checks out

9377 N Haggerty Rd
Plymouth, MI 48170
Phone: (734) 451-0070
Fax: (734) 451-1583
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 22301 Kelly Rd, Eastpointe, MI 48021-2619 — (586) 443-5588

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601006317 (MI)

Record details

NPI number1083988323
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 5, 2012
Last updated in NPPESOctober 22, 2019

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Park Family Health Care Pc — 20 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Plymouth