Healthcare Provider Details

I. General information

NPI: 1982544813
Provider Name (Legal Business Name): DESPINA TSITLAKIDOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27650 DEQUINDRE RD STE 3100
WARREN MI
48092-2818
US

IV. Provider business mailing address

12000 E 12 MILE RD
WARREN MI
48093-3570
US

V. Phone/Fax

Practice location:
  • Phone: 248-546-2600
  • Fax: 248-546-2604
Mailing address:
  • Phone: 248-207-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: