Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kristin Dicello, PA-C

Individual provider Physician Assistant · NPI 1912444142

Kristin Dicello, PA-C is a Physician Assistant in Novi, Michigan. Qualified in 2016, 10 years ago. Practices with Henry Ford Health Providence Hospital, a 350-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
10
Licensed in
MI
In the registry since
2017
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

47601 Grand River Ave Ste C202
Novi, MI 48374-1233
Phone: (248) 465-5955
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601008080 (MI)

Record details

NPI number1912444142
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 26, 2017
Last updated in NPPESJanuary 26, 2017

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Henry Ford Health Providence Hospital — 350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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