Individual
SARAH DUTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(217) 383-3311
Mailing address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036113555
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2613
MEDICARE GROUP #
—
Enumeration date
07/11/2006
Last updated
11/17/2009
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