Provider Demographics
NPI:1053381798
Name:POTTI, ESTHER (MD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:POTTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8306
Mailing Address - Country:US
Mailing Address - Phone:218-694-2384
Mailing Address - Fax:218-694-6687
Practice Address - Street 1:123 4TH ST NW
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-8306
Practice Address - Country:US
Practice Address - Phone:218-694-2384
Practice Address - Fax:218-694-6687
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN951544500Medicaid
MN951544500Medicaid
MNI39181Medicare UPIN