Provider Demographics
NPI:1245503705
Name:LJUDMIL KLJUSEV MD, LLC
Entity type:Organization
Organization Name:LJUDMIL KLJUSEV MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LJUDMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLJUSEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-693-3500
Mailing Address - Street 1:227 NAUGATUCK AVE
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:
Mailing Address - Fax:
Practice Address - Street 1:227 NAUGATUCK AVE
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039302103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2600003689Medicare UPIN