MEDICARE: SISIRA RANASINGHE M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	291U230900	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15D0966899	OTHER	IN	CLIA LABORATORY NUMBER

General Provider Information

NPI Number	:	1164644670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISIRA RANASINGHE M.D., INC.

Provider Business Mailing Address
First Line	:	228D, EAST COLLINS ROAD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5394
Country	:	US
Telephone Number	:	260-471-7675
Fax Number	:	260-471-0701

Provider Business Practice Location Address
First Line	:	228D, EAST COLLINS ROAD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5394
Country	:	US
Telephone Number	:	260-471-7675
Fax Number	:	260-471-0701

Authorized Official
Title or Position	:	LABORATORY DIRECTOR
Name	:	DR. SISIRA RANASINGHE
Credential	:	M.D.
Telephone Number	:	260-471-7675

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/09/2008

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