Provider Demographics
NPI:1275551186
Name:MISHELEVICH, LYUDMILA (MD)
Entity type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:
Last Name:MISHELEVICH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VENTURE CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-7788
Mailing Address - Country:US
Mailing Address - Phone:706-468-7002
Mailing Address - Fax:706-468-7020
Practice Address - Street 1:545 VENTURE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-7788
Practice Address - Country:US
Practice Address - Phone:706-468-7002
Practice Address - Fax:706-468-7020
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89668207Q00000X
GA103566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI10359Medicare UPIN