Desanka Stipic-Petrovic, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

060579 Issued in MI

Practice address

19900 E. 10 Mile Road
Suite 102
St. Clair Shores, MI 48080-4412

Phone

(586) 776-3366

Fax

(586) 774-1808

NPI assigned

Jun 2, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Desanka Stipic Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1174527436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19900 E. 10 MILE ROAD",
            "address_2": "SUITE 102",
            "city": "ST. CLAIR SHORES",
            "state": "MI",
            "postal_code": "480804412",
            "telephone_number": "586-776-3366",
            "fax_number": "586-774-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19900 E. 10 MILE ROAD",
            "address_2": "SUITE 102",
            "city": "ST. CLAIR SHORES",
            "state": "MI",
            "postal_code": "480804412",
            "telephone_number": "586-776-3366",
            "fax_number": "586-774-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIPIC-PETROVIC",
        "first_name": "DESANKA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-02",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "060579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3018457 TYPE10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DESANKA",
            "last_name": "STIPIC",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Psychiatry Physician in St. Clair Shores, MI
• Providers in St. Clair Shores, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.