Organization
HARSHA P JAYATILAKE MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARSHA P JAYATILAKE M.D. (PRESIDENT)
(734) 591-1300
Entity
Organization
Contact information
Practice address
37663 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 591-1300
(734) 591-1344
Mailing address
PO BOX 32588, DETROIT, MI 48232-0588
(734) 591-1300
(734) 591-1344
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4383133
—
MI
Enumeration date
05/17/2007
Last updated
08/22/2020
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