Healthcare Provider Details

I. General information

NPI: 1467201202
Provider Name (Legal Business Name): KRISTINA DJELAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42140 VAN DYKE AVE STE 190
STERLING HEIGHTS MI
48314-3679
US

IV. Provider business mailing address

45437 DESHON ST APT 1
UTICA MI
48317-5682
US

V. Phone/Fax

Practice location:
  • Phone: 313-656-4052
  • Fax: 313-656-4053
Mailing address:
  • Phone: 586-222-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851118171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: