Healthcare Provider Details

I. General information

NPI: 1922083609
Provider Name (Legal Business Name): ARUNA LANKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BIDDLE AVE
WYANDOTTE MI
48192-7205
US

IV. Provider business mailing address

15500 LUNDY PKWY
DEARBORN MI
48126-2778
US

V. Phone/Fax

Practice location:
  • Phone: 734-284-2026
  • Fax:
Mailing address:
  • Phone: 313-586-5011
  • Fax: 313-792-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301074296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: