Individual
SUDIP DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
639 TANYA COURT DR, SAINT LOUIS, MO 63129-2555
(270) 804-8025
Mailing address
639 TANYA COURT DR, SAINT LOUIS, MO 63129-2555
(270) 804-8025
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TP647
KY
207RC0000X
Cardiovascular Disease Physician
Primary
2012029909
MO
207RC0000X
Cardiovascular Disease Physician
TP647
KY
207UN0901X
Nuclear Cardiology Physician
2012029909
MO
207UN0901X
Nuclear Cardiology Physician
TP647
KY
Other
Enumeration date
06/02/2009
Last updated
08/14/2013
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