Individual
CARLA WILKS POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
17197 N LAUREL PARK DR, SUITE 161, LIVONIA, MI 48152-2680
(734) 338-8300
(734) 338-8301
Mailing address
17197 N LAUREL PARK DR, SUITE 161, LIVONIA, MI 48152-2680
(734) 338-8300
(734) 338-8301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2497
CT
363A00000X
Physician Assistant
Primary
5601006325
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H231390
BCBS GROUP NUMBER
MI
Enumeration date
10/15/2010
Last updated
04/25/2012
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