Dmitriy Petrov, M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

5333 McAuley Drive
Suite 4001
Ypsilanti, MI 48197-8633

Phone

(734) 712-3980

NPI assigned

Jun 23, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1699126458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 WOODRIDGE WAY",
            "address_2": "UNIT 2439 APT 1A",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DRIVE",
            "address_2": "SUITE 4001",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481978633",
            "telephone_number": "734-712-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROV",
        "first_name": "DMITRIY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Isabelle Peshkin
• Stevany L Peters, M.D.
• Michael R Petersen, MD
• Adam Fine Petraglia
• Emma-Leigh Petrock
• Stella Petrovici, PHARMD
• Hoang Tran Pham, MD
• Michele Philipp, RNFA
• Walter Eric Phillips, D.D.S.
• William Phillips

• Student in an Organized Health Care Education/Training Program in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Student in an Organized Health Care Education/Training Program in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.