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

Stephen Robert Tisdale, MSPAS, PA-C

Individual provider Physician Assistant · NPI 1790212728

Stephen Robert Tisdale, MSPAS, PA-C is a Physician Assistant in Toledo, Ohio. Qualified in 2017, 9 years ago. Practices with Promedica Central Physicians, a 784-clinician group and accepts Medicare assignment. Licensed in Michigan and Ohio.

Years since qualifying
9
Licensed in
MI, OH
In the registry since
2017
Specialties on file
2
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

2865 N Reynolds Rd Bldg A
Toledo, OH 43615-2100
Phone: (419) 578-7200
Fax: (419) 537-5600
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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 50.008487RX (OH)
Physician Assistant Taxonomy 363A00000X · Licence 5601008212 (MI)

Record details

NPI number1790212728
Entity typeIndividual (Type 1)
GenderMale
Credentials MSPAS , PA-C
Sole proprietorNo
NPI enumeratedMay 22, 2017
Last updated in NPPESNovember 21, 2023
Certification dateNovember 21, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Promedica Central Physicians — 784 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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