Individual
HARSHA PERERA JAYATILAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37663 PEMBROKE AVE, LIVONIA, MI 48152-1050
(743) 591-1300
(734) 591-1344
Mailing address
37663 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 591-1300
(734) 591-1344
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301062267
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4383133
—
MI
Enumeration date
05/12/2006
Last updated
03/07/2023
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