Individual
SOUMITRA DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13355 E 10 MILE RD, MEDICAL EDUCATION OFFICE, WARREN, MI 48089-2048
(586) 759-7300
Mailing address
13355 E 10 MILE RD, MEDICAL EDUCATION OFFICE, WARREN, MI 48089-2048
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
302334
NY
207R00000X
Internal Medicine Physician
5101015964
MI
Other
Enumeration date
05/31/2007
Last updated
10/19/2020
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