Healthcare Provider Details

I. General information

NPI: 1396742367
Provider Name (Legal Business Name): VLADIMIR LIPOVETSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 E STADIUM BLVD STE 208
ANN ARBOR MI
48104-4803
US

IV. Provider business mailing address

2311 E STADIUM BLVD STE 208
ANN ARBOR MI
48104-4803
US

V. Phone/Fax

Practice location:
  • Phone: 310-846-7390
  • Fax:
Mailing address:
  • Phone: 310-846-7390
  • Fax: 818-583-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG77605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: