Provider Demographics
NPI:1730358383
Name:IVAN LJUBIC, M.D., P.S.C
Entity type:Organization
Organization Name:IVAN LJUBIC, M.D., P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. -DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LJUBIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-893-7336
Mailing Address - Street 1:4001 KRESGE WAY
Mailing Address - Street 2:SUITE 236
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-893-7336
Mailing Address - Fax:502-896-9453
Practice Address - Street 1:4001 KRESGE WAY
Practice Address - Street 2:SUITE 236
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-893-7336
Practice Address - Fax:502-896-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
KY35831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000248561OtherANTHEM BLUE CROSS
KY1171348OtherPASSPORT
KY65939449Medicaid
KY7867Medicare PIN