Healthcare Provider Details

I. General information

NPI: 1578268439
Provider Name (Legal Business Name): RENISHA REDIJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 10/09/2026
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

IHA HOSPITAL MEDICINE SERVICES 5301 MCAULEY DRIVE
YPSILANTI MI
48197
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8676
  • Fax: 734-793-2471
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-793-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301518369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: