Healthcare Provider Details

I. General information

NPI: 1982527263
Provider Name (Legal Business Name): STANISLAV VASILEVSKII MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CHRYSLER DR STE 4A
DETROIT MI
48201-2167
US

IV. Provider business mailing address

3990 JOHN R ST
DETROIT MI
48201-2097
US

V. Phone/Fax

Practice location:
  • Phone: 877-929-6342
  • Fax: 313-577-8841
Mailing address:
  • Phone: 313-745-9649
  • Fax: 313-993-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4351057155
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: