Individual
MICHAEL J POTEGAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
516 DELAWARE STREET SE, PWB FOURTH FLOOR, ROOM 4-100, MINNEAPOLIS, MN 55455
(612) 625-7466
Mailing address
420 DELAWARE STREET SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 625-7466
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP4310
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492031
—
MT
01
—
1029892
PREFERRED ONE
MN
05
—
10387
—
ND
01
—
140910
UCARE
MN
01
—
1497309
ARAZ
MN
01
—
163A1PO
BLUE CROSS BLUE SHIELD
MN
05
—
7777470
—
SD
01
—
HP40584
HEALTH PARTNERS
MN
Enumeration date
10/24/2006
Last updated
07/08/2007
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