Provider Demographics
NPI:1164422283
Name:POTEMPA, LESTER EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:EDWARD
Last Name:POTEMPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3729
Mailing Address - Country:US
Mailing Address - Phone:248-746-0342
Mailing Address - Fax:248-746-0308
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:132
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-849-3301
Practice Address - Fax:248-849-5378
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010095562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI434835911Medicaid
MI0F36490009Medicare ID - Type Unspecified
MI434835911Medicaid