Individual
DR. SHOURIK DUTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 617-3748
Mailing address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2021019663
MO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
2021019663
MO
Other
Enumeration date
06/28/2021
Last updated
04/24/2026
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