MEDICARE: LAITH POTROUS MD PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861155772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAITH POTROUS MD PLLC

Provider Business Mailing Address
First Line	:	5843 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-549-7286
Fax Number	:

Provider Business Practice Location Address
First Line	:	5843 17 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-6873
Country	:	US
Telephone Number	:	586-549-7286
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAITH POTROUS
Credential	:
Telephone Number	:	586-549-7286

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	07/31/2023

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