Individual provider Active NPI

Vladimir Lipovetsky, M.D.

  • Psychiatry Physician
  • Ann Arbor, MI
National Provider Identifier
1396742367
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
G77605 Issued in CA
Practice address
2311 E Stadium Blvd Ste 208
Ann Arbor, MI 48104-4803
Phone
(310) 846-7390
NPI assigned
Jul 5, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychoanalyst 102L00000X
Psychiatry Physician 2084P0800X G77605 CA Primary

Addresses

Primary practice location

2311 E Stadium Blvd Ste 208
Ann Arbor, MI 48104-4803

Mailing address

2311 E Stadium Blvd Ste 208
Ann Arbor, MI 48104-4803
Phone (310) 846-7390

Other identifiers 1

IdentifierTypeStateIssuer
G77605OtherCAMEDICAL LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective Apr 1, 2019 through Apr 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1396742367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 E STADIUM BLVD STE 208",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044803",
            "telephone_number": "310-846-7390",
            "fax_number": "818-583-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 E STADIUM BLVD STE 208",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044803",
            "telephone_number": "310-846-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPOVETSKY",
        "first_name": "VLADIMIR",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G77605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE NUMBER",
            "identifier": "G77605",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.