Provider Demographics
NPI:1033196688
Name:POTTS, STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:POTTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:#11-230
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-642-6868
Mailing Address - Fax:312-642-2902
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:#11-230
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-642-6868
Practice Address - Fax:312-642-2902
Is Sole Proprietor?:No
Enumeration Date:2005-12-26
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076672Medicaid
IL31604381OtherBLUE CROSS BLUE SHIELD
IL036076672Medicaid
ILIL5587Medicare PIN