Healthcare Provider Details

I. General information

NPI: 1962440867
Provider Name (Legal Business Name): AMARISH P POTNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 N SAGINAW RD
MIDLAND MI
48640-4555
US

IV. Provider business mailing address

3007 N SAGINAW RD
MIDLAND MI
48640-4555
US

V. Phone/Fax

Practice location:
  • Phone: 989-633-1400
  • Fax:
Mailing address:
  • Phone: 989-633-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAP085843
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085843
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301085843
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: