Provider Demographics
NPI:1538862008
Name:ENWEREJI, NDIDI O (MD)
Entity type:Individual
Prefix:
First Name:NDIDI
Middle Name:O
Last Name:ENWEREJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 2ND AVE APT 729
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2756
Mailing Address - Country:US
Mailing Address - Phone:240-175-5389
Mailing Address - Fax:
Practice Address - Street 1:901 TOWER DR STE 420
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2827
Practice Address - Country:US
Practice Address - Phone:800-367-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301512551207N00000X
MI5315240684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology