Healthcare Provider Details

I. General information

NPI: 1467904367
Provider Name (Legal Business Name): MIRSIDA ZHOLI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ORCHARD LAKE RD
PONTIAC MI
48341-2244
US

IV. Provider business mailing address

PO BOX 430150
PONTIAC MI
48343-0150
US

V. Phone/Fax

Practice location:
  • Phone: 248-724-7600
  • Fax: 248-636-4043
Mailing address:
  • Phone: 248-724-7600
  • Fax: 248-636-4043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704289178
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: