| Modini Liyanage Pllc | |
|
1203 S Wayne Rd Westland MI 48186-4362 | |
| (248) 719-8117 | |
| (248) 449-8085 |
| Full Name | Modini Liyanage Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1203 S Wayne Rd, Westland, Michigan |
| Authorized Official Name and Position | Modini C Liyanage (OWNER) |
| Authorized Official Contact | 2487198117 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modini Liyanage Pllc 1203 S Wayne Rd Westland MI 48186-4362 Ph: (734) 895-9200 | Modini Liyanage Pllc 1203 S Wayne Rd Westland MI 48186-4362 Ph: (248) 719-8117 |
| NPI Number | 1588353593 |
|---|---|
| Provider Enumeration Date | 05/04/2023 |
| Last Update Date | 01/19/2024 |
| Medicare PECOS PAC ID | 5395101380 |
|---|---|
| Medicare Enrollment ID | O20230517001558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588353593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Modini Chintha Liyanage |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457450413 PECOS PAC ID: 3779476205 Enrollment ID: I20040206000570 |
| Provider Name | Tarik A Ali |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477068310 PECOS PAC ID: 9931528585 Enrollment ID: I20200930002758 |
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