MEDICARE: DR. NIKOLAJ KLJUSEV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	ME167920	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	ME167920	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417539479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKOLAJ KLJUSEV MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-2052
Fax Number	:	239-343-5348

Provider Business Practice Location Address
First Line	:	9981 S HEALTHPARK DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-3618
Country	:	US
Telephone Number	:	392-343-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	06/29/2026

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