Provider Demographics
NPI:1053679852
Name:KRUZHKOV, LYUDMILA E (MD)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:E
Last Name:KRUZHKOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYUDMILA
Other - Middle Name:E
Other - Last Name:MIKHNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3002 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4567
Mailing Address - Country:US
Mailing Address - Phone:703-853-0063
Mailing Address - Fax:
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2367
Practice Address - Country:US
Practice Address - Phone:360-501-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282174207R00000X
WA60709743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine