Provider Demographics
NPI:1376645366
Name:POTTS, CAROL WILTSE (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:WILTSE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2448 S 102ND ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2466
Mailing Address - Country:US
Mailing Address - Phone:414-543-9600
Mailing Address - Fax:414-543-9601
Practice Address - Street 1:2448 S 102ND ST
Practice Address - Street 2:SUITE 270
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2466
Practice Address - Country:US
Practice Address - Phone:414-543-9600
Practice Address - Fax:414-543-9601
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI28417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B55819Medicare UPIN