Provider Demographics
NPI:1679688808
Name:POTTER, ARTHUR JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:JAMES
Last Name:POTTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1450 FARR RD
Mailing Address - Street 2:SUITE 5000
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-9738
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:231-722-5147
Practice Address - Street 1:1450 FARR RD
Practice Address - Street 2:SUITE 5000
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9738
Practice Address - Country:US
Practice Address - Phone:231-739-9095
Practice Address - Fax:231-722-5147
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAP050009207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104555701Medicaid
MI104555701Medicaid
MIN81710001Medicare ID - Type Unspecified