Individual
DEEMANTHA GAYAN FERNANDO WIJEKULASOORIYAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-5725
(414) 219-5611
Mailing address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-5725
(414) 219-5611
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/21/2022
Last updated
03/21/2022
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