Provider Demographics
NPI:1891869566
Name:KLJUSEV, LJUDMIL (MD)
Entity Type:Individual
Prefix:
First Name:LJUDMIL
Middle Name:
Last Name:KLJUSEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 NAUGATUCK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-5540
Mailing Address - Country:US
Mailing Address - Phone:203-693-3500
Mailing Address - Fax:203-693-3501
Practice Address - Street 1:227 NAUGATUCK AVENUE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-5540
Practice Address - Country:US
Practice Address - Phone:203-693-3500
Practice Address - Fax:203-693-3501
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0393022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1393024Medicaid
H34152Medicare UPIN
2600003689H34152Medicare UPIN
2600003689Medicare ID - Type Unspecified