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NPI Code Detail

MEDICARE: DR. PRASANI NILWALA JAYATILAKE M.D.

MEDICARE: DR. PRASANI NILWALA JAYATILAKE 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
1207Q00000XFamily Medicine Physician4301075100MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548211832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRASANI NILWALA JAYATILAKE M.D.
Provider Business Mailing Address
First Line : 13210 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48215-2704
Country : US
Telephone Number : 313-335-3444
Fax Number :
Provider Business Practice Location Address
First Line : 13210 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48215-2704
Country : US
Telephone Number : 313-335-3444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 09/25/2025

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