Individual
MEVAN NANDAKA WIJETUNGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 S COLUMBIA RD, GRAND FORKS, ND 58201
(701) 780-6236
(701) 780-6221
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48798
MN
207RC0000X
Cardiovascular Disease Physician
48798
MN
207RC0000X
Cardiovascular Disease Physician
MDE33460
DC
207RC0001X
Clinical Cardiac Electrophysiology Physician
11101
ND
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
48798
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034425200
—
DC
05
—
15880581
—
VA
05
—
400766200
—
MD
05
—
967611200
—
MN
Enumeration date
05/31/2006
Last updated
12/22/2020
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