Healthcare Provider Details

I. General information

NPI: 1225730625
Provider Name (Legal Business Name): ENEA GJOKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W BRISTOL RD STE 150
FLINT MI
48507-3161
US

IV. Provider business mailing address

4444 W BRISTOL RD STE 150
FLINT MI
48507-3161
US

V. Phone/Fax

Practice location:
  • Phone: 833-322-3376
  • Fax:
Mailing address:
  • Phone: 833-322-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301512793
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: