Provider Demographics
NPI:1841302072
Name:POTEMPA, ROBERT LOUIS (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:POTEMPA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:773-889-3353
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:773-889-3353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002711213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002711Medicaid
T36920Medicare UPIN
IL016002711Medicaid