| Doctor Name: | GARY POTVIN |
| NPI Number: | 1508019639 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 5619 Loon Dr Big Lake, MN - 553098984 |
| Business Phone Number: | 6125986626 |
| Business Fax Number: | |
| Mailing Address: | 5619 Loon Dr, BIG LAKE |
| State: | MN |
| Postal Code: | 553098984 |
| Phone Number: | 6125986626 |
| Fax Number: | |
| NPI Enumeration Date: | 11/03/2008 |
| NPI Last Update Date: | 11/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |