Provider Demographics
NPI:1003960899
Name:DUTT, KATIKUTI ESWARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATIKUTI
Middle Name:ESWARA
Last Name:DUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27124 WINGED ELM DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7773
Mailing Address - Country:US
Mailing Address - Phone:813-991-6787
Mailing Address - Fax:813-991-6758
Practice Address - Street 1:27124 WINGED ELM DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7773
Practice Address - Country:US
Practice Address - Phone:813-991-6787
Practice Address - Fax:813-991-6758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID83098Medicare UPIN
MI0253295Medicare ID - Type UnspecifiedI HAVE MOVED TO FLORIDA