Healthcare Provider Details

I. General information

NPI: 1821892290
Provider Name (Legal Business Name): TEREZINA KOJE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEREZINA MALAJ DO

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

41639 TERA LN
NOVI MI
48375-1867
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-1601
  • Fax:
Mailing address:
  • Phone: 248-568-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151017161
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: