Individual provider · NPI-1

Sudip Datta, MD

Internal Medicine, Cardiovascular Disease · Saint Louis, MO

NPI number1366678567
StatusActive
Last updated in NPPESAug 14, 2013

Details

NPI
1366678567
Entity type
Individual (NPI-1)
Name
Sudip Datta
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jun 2, 2009
Last updated
Aug 14, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RC0000X Internal Medicine, Cardiovascular Disease2012029909MOYes
207R00000X Internal MedicineTP647KY
207RC0000X Internal Medicine, Cardiovascular DiseaseTP647KY
207UN0901X Nuclear Medicine, Nuclear CardiologyTP647KY
207UN0901X Nuclear Medicine, Nuclear Cardiology2012029909MO

Practice location

639 Tanya Court Dr
Saint Louis, MO 63129-2555

Phone 270-804-8025

Mailing address

639 Tanya Court Dr
Saint Louis, MO 63129-2555

Phone 270-804-8025

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Internal Medicine, Cardiovascular Disease providers in Saint Louis, MO