Individual
LABUTALE WALAWWE RAJAGURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-4491
(715) 817-7100
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
14754
MN
363A00000X
Physician Assistant
Primary
7735
WI
Other
Enumeration date
02/23/2024
Last updated
02/23/2024
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