Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036-132645 | IL |
Y | 111NI0900X | Internist | 036-132645 | IL |
N | 207R00000X | Internist | 238252 | MA |
N | 111NI0900X | Internist | 238252 | MA |
N | 207R00000X | Internist | ME110370 | FL |
N | 111NI0900X | Internist | ME110370 | FL |
NPI | 1003069535 |
---|---|
Provider Name | Suparna Dutta |
First Address | Chicago, IL 60612-5500 |
Second Address | Chicago, IL 60612-5500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 14/05/2013 |