Individual
DR. KEVIN POTHOVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 6TH AVE, DES MOINES, IA 50314-2613
(515) 247-3211
(515) 643-8722
Mailing address
PO BOX 4925, DES MOINES, IA 50305-4925
(515) 643-4374
(515) 643-2784
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301078608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06127
BC/BS OF IOWA
IA
05
—
104631572
—
MI
05
—
104703457
—
MI
01
—
KP078608
BC/BS OF MICHIGAN
MI
Enumeration date
05/30/2006
Last updated
06/09/2009
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