Provider Demographics
NPI:1821186297
Name:MILICI, LINDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:MILICI
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 1:6 BUSINESS PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-315-3326
Mailing Address - Fax:203-483-8322
Practice Address - Street 1:6 BUSINESS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-315-3326
Practice Address - Fax:203-483-8322
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0266742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V7658OtherHEALTHNET
CT010028674CT08OtherANTHEM BCBS
CT010028674CT09OtherANTHEM
CT010028674CT10OtherANTHEM BCBS
CT2020293OtherAETNA
CT300084629OtherRAILROAD MEDICARE
CT784315OtherCONNECTICARE
CT001286740Medicaid
CTANC1300OtherOXFORD
CT0V7658OtherHEALTHNET
CT010028674CT08OtherANTHEM BCBS
CT300002919Medicare PIN
CT300002916Medicare PIN