Individual
PRASHAN GUNASEKERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2414 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3129
(920) 457-4461
(920) 459-1483
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301107370
MI
207Q00000X
Family Medicine Physician
Primary
66946
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067567
—
WI
05
—
1770848194
—
WI
01
—
K400388841
MEDICARE
WI
Enumeration date
07/11/2012
Last updated
10/13/2023
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