Healthcare Provider Details

I. General information

NPI: 1508448564
Provider Name (Legal Business Name): AMAN DUTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date: 02/24/2022
Reactivation Date: 03/22/2022

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR RM 714
MOBILE AL
36617-2300
US

V. Phone/Fax

Practice location:
  • Phone: 773-299-6591
  • Fax:
Mailing address:
  • Phone: 773-299-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48593
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: