Provider Demographics
NPI:1629235403
Name:TIKIRI RATNAYAKE M.D., INC.
Entity Type:Organization
Organization Name:TIKIRI RATNAYAKE M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-756-2100
Mailing Address - Street 1:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1249
Mailing Address - Country:US
Mailing Address - Phone:219-464-8115
Mailing Address - Fax:
Practice Address - Street 1:1910 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2704
Practice Address - Country:US
Practice Address - Phone:219-464-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01028333261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085652OtherBLUE CROSS PIN
IN000000084568OtherBLUE CROSS PIN
IN000000085652OtherBLUE CROSS PIN
INE0570Medicare UPIN