Provider Demographics
NPI:1245688191
Name:MIJOVIC, VASILIJE (MD)
Entity type:Individual
Prefix:
First Name:VASILIJE
Middle Name:
Last Name:MIJOVIC
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 1:100 RETREAT AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2553
Mailing Address - Country:US
Mailing Address - Phone:860-218-2204
Mailing Address - Fax:860-461-0224
Practice Address - Street 1:100 RETREAT AVE STE 900
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2553
Practice Address - Country:US
Practice Address - Phone:860-218-2204
Practice Address - Fax:860-461-0224
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66764207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology