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NPI Code Detail

MEDICARE: DR. JESSICA MICHAJLYSZYN DESPOTOVIC M.D.

MEDICARE: DR. JESSICA MICHAJLYSZYN DESPOTOVIC M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician2008016209MO

General Provider Information

NPI Number : 1346455490
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA MICHAJLYSZYN DESPOTOVIC M.D.
Provider Business Mailing Address
First Line : 1717 BIDDLE ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63106-3454
Country : US
Telephone Number : 314-814-8531
Fax Number : 314-814-8542
Provider Business Practice Location Address
First Line : 6763 PAGE AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63133-1635
Country : US
Telephone Number : 314-814-8700
Fax Number : 314-814-8542
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 10/05/2022

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