Individual
VIDUSHANI SRIYANKA PERERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
250 E SUPERIOR ST STE 4-2304, CHICAGO, IL 60611-2914
(312) 695-5753
(312) 695-5645
Mailing address
PO BOX 980615, RICHMOND, VA 23298-0615
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036163937
IL
390200000X
Student in an Organized Health Care Education/Training Program
0116031528
VA
390200000X
Student in an Organized Health Care Education/Training Program
125077249
IL
Other
Enumeration date
04/07/2017
Last updated
11/13/2023
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