MEDICARE: DR. THILI N KULATILAKE M.D.

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	207Q00000X	Family Medicine Physician	21515	AZ

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

General Provider Information

NPI Number	:	1396846390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THILI N KULATILAKE M.D.

Provider Business Mailing Address
First Line	:	4721 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5610
Country	:	US
Telephone Number	:	520-887-0035
Fax Number	:	520-888-0134

Provider Business Practice Location Address
First Line	:	4721 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5610
Country	:	US
Telephone Number	:	520-887-0035
Fax Number	:	520-888-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	04/18/2008

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