Provider Demographics
NPI:1003418823
Name:PAUL POTACH D.P.M.,P.C.
Entity Type:Organization
Organization Name:PAUL POTACH D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:POTACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-484-3338
Mailing Address - Street 1:3100 SOUTH OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402
Mailing Address - Country:US
Mailing Address - Phone:708-484-3338
Mailing Address - Fax:708-484-2059
Practice Address - Street 1:3100 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3291
Practice Address - Country:US
Practice Address - Phone:708-484-3338
Practice Address - Fax:708-484-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site