Individual
SENAKA Y. RATNAYAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601
(574) 647-7477
(574) 647-3655
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01078683A
IN
207Q00000X
Family Medicine Physician
11018128A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300013891
—
IN
Enumeration date
07/02/2015
Last updated
05/29/2018
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