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General NPI Number Information
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NPI Number | 1750553665
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Entity Type | Individual
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Provider Name | ANKUR DATTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 4123 DUTCHMANS LN STE 606
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City | LOUISVILLE
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State | KY
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Zip | 40207-4725
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Country | US
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Telephone | 502-896-2500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-2991
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 036.128019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 58279
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License Number State | KY
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