Provider Demographics
NPI:1346455490
Name:DESPOTOVIC, JESSICA MICHAJLYSZYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MICHAJLYSZYN
Last Name:DESPOTOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:MICHAJLYSZYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1717 BIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-3454
Mailing Address - Country:US
Mailing Address - Phone:314-814-8531
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:6763 PAGE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1635
Practice Address - Country:US
Practice Address - Phone:314-814-8700
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology