Individual
DR. NILUPA SEWWANDI GASPE MUDIYANSELAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6220
(618) 257-6679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036146147
IL
208M00000X
Hospitalist Physician
Primary
036-146147
IL
Other
Enumeration date
06/26/2015
Last updated
02/11/2021
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