Dutta, Gautam
Dutta, Gautam is an individual health care provider with primary practice located at 1 Medical Center Blvd Suite 103, Cookeville TN 38501-4294. He recently has only one registered license in Allopathic & Osteopathic Physicians / Hospitalist, which is considered as his primary health care specialty. Dutta, Gautam can be contacted via phone (931) 783-2770.Contact Information
Primary practice address
1 Medical Center Blvd Suite 103
Cookeville TN 38501-4294
Phone: (931) 783-2770
Fax: (931) 525-1176
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | MD45220 | Tennessee |
Profile Details
| NPI number | 1245352970 |
|---|---|
| LBN Legal business name | Dutta, Gautam |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 4th, 2007 |
| Last updated | Dec 29th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245352970 | NPPES |
| Tennessee | MEDICAID | 1516195 |
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