Provider Demographics
NPI:1750366605
Name:POTTS, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:27472 SCHOENHERR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6675
Mailing Address - Country:US
Mailing Address - Phone:586-751-8844
Mailing Address - Fax:586-751-8596
Practice Address - Street 1:27472 SCHOENHERR RD STE 100
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6675
Practice Address - Country:US
Practice Address - Phone:586-751-8844
Practice Address - Fax:586-751-8596
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301073376207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4910891Medicaid
MI4910891Medicaid
MI0N78540017Medicare ID - Type Unspecified
MII32266Medicare UPIN