MEDICARE: DR. RANI THANGAM POTTI M.D. M.P.H.

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	4301058831	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	136969	OTHER	MI	CARE CHOICESHMO
2	08-0-63-4196-2	OTHER	MI	BLUE CROSS BLUE SHIELD
3	CIGNA	OTHER	MI	CIGNA
4	5894046	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1811996333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANI THANGAM POTTI M.D. M.P.H.

Provider Business Mailing Address
First Line	:	18249 CASCADE DR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-3288
Country	:	US
Telephone Number	:	248-596-9580
Fax Number	:	313-278-8729

Provider Business Practice Location Address
First Line	:	4215 S BEECH DALY ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1567
Country	:	US
Telephone Number	:	313-278-7750
Fax Number	:	313-278-8729

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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