Organization
CHARLES R. POTTER, M.D., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES R POTTER M.D. (OWNER)
(217) 422-1199
Entity
Organization
Contact information
Practice address
1770 E LAKE SHORE DR, SUITE 306, DECATUR, IL 62521-3832
(217) 422-1199
(217) 422-1277
Mailing address
1770 E LAKE SHORE DR, SUITE 306, DECATUR, IL 62521-3832
(217) 422-1199
(217) 422-1277
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036-065056
IL
Other
Enumeration date
10/04/2006
Last updated
06/19/2008
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