Provider Demographics
NPI:1316104177
Name:NEELAM DUTT MD PC
Entity type:Organization
Organization Name:NEELAM DUTT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-9000
Mailing Address - Street 1:G3535 BEECHER RD STE H
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2700
Mailing Address - Country:US
Mailing Address - Phone:810-732-9000
Mailing Address - Fax:810-732-8370
Practice Address - Street 1:G3535 BEECHER RD STE H
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2700
Practice Address - Country:US
Practice Address - Phone:810-732-9000
Practice Address - Fax:810-732-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIND407280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4289383Medicaid
MI4289383Medicaid