Healthcare Provider Details

I. General information

NPI: 1508728791
Provider Name (Legal Business Name): ERDONIT JAHAJ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BYRON CENTER AVE SW
WYOMING MI
49519-9606
US

IV. Provider business mailing address

1004 36TH ST SW APT C2
WYOMING MI
49509-3571
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7200
  • Fax:
Mailing address:
  • Phone: 616-516-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704399449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: