Provider Demographics
NPI:1376287169
Name:GJOLAJ, CHRISTIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:GJOLAJ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2531
Mailing Address - Country:US
Mailing Address - Phone:248-716-8600
Mailing Address - Fax:248-565-8121
Practice Address - Street 1:350 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2531
Practice Address - Country:US
Practice Address - Phone:248-716-8600
Practice Address - Fax:248-565-8121
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601011133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant