Healthcare Provider Details

I. General information

NPI: 1568395770
Provider Name (Legal Business Name): RUDINA GOJCAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W BIG BEAVER RD
TROY MI
48084-3522
US

IV. Provider business mailing address

15287 YELLOWSTONE DR
MACOMB MI
48042-5646
US

V. Phone/Fax

Practice location:
  • Phone: 248-878-3171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704358444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: