Provider Demographics
NPI:1255384855
Name:RATNAYAKE, TIKIRI (MD INC)
Entity type:Individual
Prefix:
First Name:TIKIRI
Middle Name:
Last Name:RATNAYAKE
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2704
Mailing Address - Country:US
Mailing Address - Phone:219-464-3696
Mailing Address - Fax:219-464-8115
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:219-464-3696
Practice Address - Fax:219-464-8115
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01028333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084568OtherBLUE CROSS PIN
IN000000085652OtherBLUE CROSS PIN
IN000000084568OtherBLUE CROSS PIN
INE0570Medicare UPIN