Individual ProviderDeemantha Gayan Fernando WijekulasooriyageStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address945 N 12th St, Milwaukee, WI 53233-1305(414) 219-5725PECOS EnrollmentBased on the most recent information from CMS, provider Deemantha Gayan Fernando Wijekulasooriyage does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1780333567Provider TypeIndividualFull NameWijekulasooriyage, Deemantha Gayan FernandoCredentialMDGenderMaleSole ProprietorNoEnumeration Date3/21/2022Last Updated3/21/2022Contact InformationPractice LocationPractice Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-5725Fax(414) 219-5611Mailing LocationMailing Address945 N 12th St, Milwaukee, WI 53233-1305Phone(414) 219-5725Fax(414) 219-5611Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer