Healthcare Provider Details

I. General information

NPI: 1194738062
Provider Name (Legal Business Name): LUISA M MILEVOJ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MONROE TPKE CANTERBURY PEDIATRICS
MONROE CT
06468-2276
US

IV. Provider business mailing address

401 MONROE TPKE CANTERBURY PEDIATRICS
MONROE CT
06468-2276
US

V. Phone/Fax

Practice location:
  • Phone: 203-452-1063
  • Fax:
Mailing address:
  • Phone: 203-452-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number000532
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: