Provider Demographics
NPI:1124012372
Name:PLISIC, LJILJANA (MD)
Entity Type:Individual
Prefix:
First Name:LJILJANA
Middle Name:
Last Name:PLISIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-1 ROUTE 80
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-1465
Mailing Address - Country:US
Mailing Address - Phone:860-663-1275
Mailing Address - Fax:
Practice Address - Street 1:687 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3612
Practice Address - Country:US
Practice Address - Phone:203-488-8306
Practice Address - Fax:203-481-0267
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028902207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001289025Medicaid
CTE28866Medicare UPIN
CT160000926Medicare PIN