Provider Demographics
NPI:1073526810
Name:POTORKE, ISTVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ISTVAN
Middle Name:
Last Name:POTORKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2221
Mailing Address - Country:US
Mailing Address - Phone:559-686-8711
Mailing Address - Fax:559-686-1221
Practice Address - Street 1:925 E MERRITT AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2221
Practice Address - Country:US
Practice Address - Phone:559-686-8711
Practice Address - Fax:559-686-1221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39023207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A390230Medicaid
CA00A390230Medicaid
CAA28794Medicare UPIN