Healthcare Provider Details

I. General information

NPI: 1285322057
Provider Name (Legal Business Name): CAITLIN PEARL PIETILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42627 GARFIELD RD STE 214
CLINTON TOWNSHIP MI
48038-5032
US

IV. Provider business mailing address

42627 GARFIELD RD STE 214
CLINTON TOWNSHIP MI
48038-5032
US

V. Phone/Fax

Practice location:
  • Phone: 586-310-8158
  • Fax:
Mailing address:
  • Phone: 586-310-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012766
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601012766
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: