Individual
ANNESLEY T DEVASGUNAWARDHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 COMMERCE DR, CLIFTON, IL 60927-9501
(815) 694-2381
(815) 694-2256
Mailing address
102 COMMERCE DR, CLIFTON, IL 60927-9501
(815) 694-2381
(815) 694-2256
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-054736
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036054736
—
IL
Enumeration date
08/05/2006
Last updated
07/08/2007
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