Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 4301095850 | MI |
N | 208800000X | Urologist | A87127 | CA |
Y | 2088P0231X | Pediatric Urologist | 4301095850 | MI |
NPI | 1003079682 |
---|---|
Provider Name | Dr. Vesna Ivancic |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-4217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 20/11/2019 |