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General NPI Number Information
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NPI Number | 1114165453
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Entity Type | Individual
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Provider Name | VINODINEE LANKA DISSANAYAKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2009
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-947-0229
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Fax |
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Provider Business Mailing Address
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Address Line | 1653 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 312-947-0229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.127009
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207PT0002X
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Taxonomy Name | Medical Toxicology (Emergency Medicine) Physician
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License Number | 036.127009
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License Number State | IL
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