Provider Demographics
NPI:1164477550
Name:KURUKULASURIYA, LILAMANI ROMAYNE (MD)
Entity Type:Individual
Prefix:
First Name:LILAMANI
Middle Name:ROMAYNE
Last Name:KURUKULASURIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2273
Practice Address - Fax:573-884-4609
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD137430207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205202401Medicaid
KS2087187701OtherKANSAS MEDICAID
MO3300050OtherUNITED HEALTHCARE
MO445672OtherHEALTHLINK
MO131567OtherBLUE SHIELD/BLUE CHOICE
H28856Medicare UPIN
MO006011882Medicare PIN
MOP00415633Medicare PIN
KS2087187701OtherKANSAS MEDICAID
MO110214198Medicare PIN