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NPI Code Detail

MEDICARE: DR. SHOURIK DUTTA MD

MEDICARE: DR. SHOURIK DUTTA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician2021019663MO

General Provider Information

NPI Number : 1275103780
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHOURIK DUTTA MD
Provider Business Mailing Address
First Line : 1201 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1016
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1201 S GRAND BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-1016
Country : US
Telephone Number : 314-617-3748
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2021
Last Update Date : 04/24/2026

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Directions to “ DR. SHOURIK DUTTA MD” Practice Location

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