Individual
DR. JONATHAN RODERICK DUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 W KENWOOD AVE, DECATUR, IL 62526-4368
(217) 545-8000
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.071354
IL
207R00000X
Internal Medicine Physician
Primary
036-151311
IL
Other
Enumeration date
07/12/2017
Last updated
05/04/2020
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