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General NPI Number Information
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NPI Number | 1487073615
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Entity Type | Individual
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Provider Name | LAITH MATTI POTROUS MD
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 5843 17 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-6873
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Country | US
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Telephone | 586-722-7741
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Fax | 586-883-9970
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Provider Business Mailing Address
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Address Line | 5843 17 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-6873
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Country | US
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Telephone | 586-722-7741
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Fax | 586-883-9970
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301105756
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License Number State | MI
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