Individual
MONISHA DUTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
880 MADISON AVENUE, MEMPHIS, TN 38103-3409
(901) 545-6969
(901) 515-4748
Mailing address
877 JEFFERSON AVENUE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 605-4516
(901) 259-0112
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
45641
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1522219
—
TN
Enumeration date
05/04/2007
Last updated
02/14/2017
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