Healthcare Provider Details

I. General information

NPI: 1255396206
Provider Name (Legal Business Name): LJILJANA MIJATOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST.
BUFFALO NY
14222
US

IV. Provider business mailing address

219 BRYANT ST.
BUFFALO NY
14222
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7701
  • Fax: 716-878-7701
Mailing address:
  • Phone: 716-878-7701
  • Fax: 716-878-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number002096-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number246884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: