Basic Information
| Provider Information | |||||||||
| NPI: | 1881610038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUTTA | ||||||||
| FirstName: | SANJIT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990190421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096240111 | ||||||||
| FaxNumber: | 5092277070 | ||||||||
| Practice Location | |||||||||
| Address1: | 546 N JEFFERSON LN | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992017104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096240111 | ||||||||
| FaxNumber: | 5092277070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MD00049435 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 208M00000X | MD00049435 | WA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD00049435 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00033177 | 01 | MN RR | OTHER | HP39094 | 01 | HEALTHPARTNERS | OTHER | 0405796 | 01 | MEDICA | OTHER | 1034961 | 01 | PREFERREDONE | OTHER | 1875555 | 01 | AMERICAS PPO | OTHER | 23358 | 01 | ND | ND BC | OTHER | 595S1DU | 01 | MN BC | OTHER | 889696800 | 05 | MN | MEDICAID |