Provider Demographics
NPI:1518600931
Name:DUTTA, PRIYATA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYATA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
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:ACADEMIC INTERNAL MEDICINE CLINIC
Mailing Address - Street 2:5333 MCAULEY DRIVE, SUITE 4001
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8633
Mailing Address - Country:US
Mailing Address - Phone:734-773-2224
Mailing Address - Fax:
Practice Address - Street 1:ACADEMIC INTERNAL MEDICINE CLINIC
Practice Address - Street 2:5333 MCAULEY DRIVE, SUITE 4001
Practice Address - City:YPAILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-3980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program