Healthcare Provider Details

I. General information

NPI: 1184534539
Provider Name (Legal Business Name): ENEJDA PRENGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44001 GARFIELD RD
CLINTON TWP MI
48038-1100
US

IV. Provider business mailing address

1321 BOYD ST
TROY MI
48083-5405
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-3300
  • Fax:
Mailing address:
  • Phone: 586-219-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451017901
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: