1972814267 NPI number — DR. KRISHANTHI DILRUKSHI SENEVIRATNE MD

Table of content: DR. KRISHANTHI DILRUKSHI SENEVIRATNE MD (NPI 1972814267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972814267 NPI number — DR. KRISHANTHI DILRUKSHI SENEVIRATNE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENEVIRATNE
Provider First Name:
KRISHANTHI
Provider Middle Name:
DILRUKSHI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GURUGE
Provider Other First Name:
KRISHANTHI
Provider Other Middle Name:
DILRUKSHI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972814267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 E CONGRESS PKWY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60014-6248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-356-7494
Provider Business Mailing Address Fax Number:
815-356-7541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 E CONGRESS PKWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-6248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-356-7494
Provider Business Practice Location Address Fax Number:
815-356-7541
Provider Enumeration Date:
07/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036124671 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SENEVKRI . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0361246713 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972814267 . This is a "BCBSWI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".