Healthcare Provider Details

I. General information

NPI: 1447115167
Provider Name (Legal Business Name): KAITLYN MADUBUIKE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N MACOMB ST
MONROE MI
48162-3088
US

IV. Provider business mailing address

39960 NOVAPLEX CIR APT 7302
NOVI MI
48377-3388
US

V. Phone/Fax

Practice location:
  • Phone: 734-654-2169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601014151
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: