Individual
DR. MANIDEEP DUTTULURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 US HIGHWAY 61, FESTUS, MO 63028-4100
(636) 933-5337
(636) 933-8090
Mailing address
1400 US HIGHWAY 61 STE H1521, CHICAGO, IL 60677-0001
(636) 933-5337
(636) 933-8090
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2022025500
MO
208M00000X
Hospitalist Physician
036.160496
IL
208M00000X
Hospitalist Physician
2022025500
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200112170
—
MO
Enumeration date
05/14/2018
Last updated
09/25/2025
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