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NPI Code Detail

MEDICARE: MS. TIFFANY ANN POTTS PA

MEDICARE: MS. TIFFANY ANN POTTS PA
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
1363A00000XPhysician Assistant5601003398MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA050954OTHERPAMEDICAL PHYSICIAN ASST

General Provider Information

NPI Number : 1932100203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY ANN POTTS PA
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 44201 DEQUINDRE RD
Second Line :
City : TROY
State : MI
Zip : 48085-1117
Country : US
Telephone Number : 248-964-4866
Fax Number : 412-359-6620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 12/29/2020

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Directions to “ MS. TIFFANY ANN POTTS PA” Practice Location

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