Provider Demographics
NPI:1811996333
Name:POTTI, RANI THANGAM (MD MPH)
Entity type:Individual
Prefix:DR
First Name:RANI
Middle Name:THANGAM
Last Name:POTTI
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18249 CASCADE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-3288
Mailing Address - Country:US
Mailing Address - Phone:248-596-9580
Mailing Address - Fax:313-278-8729
Practice Address - Street 1:4215 S BEECH DALY ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1567
Practice Address - Country:US
Practice Address - Phone:313-278-7750
Practice Address - Fax:313-278-8729
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI136969OtherCARE CHOICESHMO
MI08-0-63-4196-2OtherBLUE CROSS BLUE SHIELD
MICIGNAOtherCIGNA
MI5894046OtherAETNA
MI5894046OtherAETNA
MICIGNAOtherCIGNA