Individual
KANISHKA THIRAN JAYASUNDERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 WALL STREET, ANN ARBOR, MI 48105-1912
(734) 764-4190
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
4301093385
MI
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
SFP53
CA
Other
Enumeration date
06/10/2011
Last updated
09/02/2025
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