Individual
DR. SUSAN LYASKO KLUGEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1500 W ELK AVE, ELIZABETHTON, TN 37643
(423) 543-2584
(423) 722-2060
Mailing address
401 E MAIN ST, JOHNSON CITY, TN 37601-4877
(423) 929-2584
(423) 722-2060
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD45116
TN
208000000X
Pediatrics Physician
ME78055
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514567
—
TN
Enumeration date
05/02/2006
Last updated
09/12/2018
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