Edward Milan Prodanovic, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2025004026 Issued in MO

Practice address

4901 Forest Park Ave
Div Im Dermatology, Ste 502
Saint Louis, MO 63108-1495

Phone

(314) 747-8688

Fax

(888) 665-8309

NPI assigned

May 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GU, TX, MO, IL4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 4

Specialty

Dermatology

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aleksandar Krunic, MD, SCGroup PAC ID 4688674260, 2 clinicians

Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1992746903
  Medicare reassignment Care Compare group NPD
• Aleksandar Krunic, MD, SC

  • MOHS-Micrographic Surgery Physician
  • Chicago, IL
  • NPI 1801967633
  Medicare reassignment Care Compare group NPD
• Epidermatology, PLLC

  • Dermatology Physician
  • Pearland, TX
  • NPI 1821567769
  Medicare reassignment NPD
• General Conference Corp of Sda

  • Clinic/Center
  • Tamuning, GU
  • NPI 1275586877
  Medicare reassignment
• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1962442475
  NPD
• Washington University

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1134169568
  NPD (past)
• Los Angeles ENT Facial Plastics Center, Inc

  • Medical Specialty Clinic/Center
  • Redondo Beach, CA
  • NPI 1225463797
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1306067640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-747-8688",
            "fax_number": "888-665-8309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 FOREST PARK AVE",
            "address_2": "DIV IM DERMATOLOGY, STE 502",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081495",
            "telephone_number": "314-747-8688",
            "fax_number": "888-665-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRODANOVIC",
        "first_name": "EDWARD",
        "middle_name": "MILAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2025-07-16",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2025004026",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2025004026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4901 Forest Park Ave",
            "address_2": "Div IM Dermatology, Ste 502",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631081495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Peggy S Probst, MA, LPC
• Procare Home Health LLC
• Sarah Jane Prochniak, MD
• Sara Susan Procknow, MD
• Linda R Proctor, MD
• Lauren Proemsey
• Profero Counseling and Consulting LLC
• Professional Athletic Orthopedics
• Professional Athletic Rehabilitation, LLC
• Professional Healthcare Providers, LLC

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.