Provider Demographics
NPI:1164696860
Name:DR ROBERT LOUIS POTEMPA DPM
Entity Type:Organization
Organization Name:DR ROBERT LOUIS POTEMPA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:POTEMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-889-3520
Mailing Address - Street 1:3144 N AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5127
Mailing Address - Country:US
Mailing Address - Phone:773-889-3520
Mailing Address - Fax:
Practice Address - Street 1:3144 N AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5127
Practice Address - Country:US
Practice Address - Phone:773-889-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0500670001Medicare NSC