Provider Demographics
NPI:1710984646
Name:POTEMPA, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:POTEMPA
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE 260
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-354-1306
Practice Address - Fax:708-354-1538
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066846207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03666846Medicaid
ILC30486OtherRR MEDICARE GROUP
IL110095959OtherRR MEDICARE INDIVIDUAL
IL1616108OtherBCBS
ILL76991Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL110095959OtherRR MEDICARE INDIVIDUAL
ILC30486OtherRR MEDICARE GROUP
IL922820Medicare ID - Type UnspecifiedGROUP NUMBER
ILL35143Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER