Look up the most recent NPI and PECOS records

Labutale Walawwe Rajaguru

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Labutale Walawwe Rajaguru is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1346006772
Provider Type
Individual
Full Name
Rajaguru, Labutale Walawwe
Credential
PA-C

Gender
Male
Sole Proprietor
No
Enumeration Date
2/23/2024
Last Updated
2/23/2024

Contact Information

Practice Location

3500 Tower Ave, Superior, WI 54880-4491

(715) 817-7100

Unlisted Fax

Mailing Location

400 E 3rd St, Duluth, MN 55805-1951

(218) 786-8364

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 7735 Wisconsin
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 14754 Minnesota

Labutale Walawwe Rajaguru

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Greiner, Anna Charlotte

Karl, Sarah Lynn

Salmela, Cord Thomas

Laflamme, Amy Marie

Johnson, Sarah Elizabeth

Kunze, Zoe

Potter, James G

Senger, Christopher Dean

Anderson, Leslie Ann

Grimm, Rhiannon Elise