MEDICARE: KRISHNAN POTTI, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01025043A	IN

General Provider Information

NPI Number	:	1669651105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISHNAN POTTI, M.D.

Provider Business Mailing Address
First Line	:	8300 BROADWAY STE B
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-8602
Country	:	US
Telephone Number	:	219-769-4616
Fax Number	:	219-736-0719

Provider Business Practice Location Address
First Line	:	8300 BROADWAY STE B
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-8602
Country	:	US
Telephone Number	:	219-769-4616
Fax Number	:	219-736-0719

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	MRS. THERESE A HINES
Credential	:
Telephone Number	:	219-769-4616

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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