Healthcare Provider Details

I. General information

NPI: 1407842958
Provider Name (Legal Business Name): ALEXANDER V. POTERMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MCHENRY RD APT 741
BUFFALO GROVE IL
60089-6898
US

IV. Provider business mailing address

250 MCHENRY RD APT 741
BUFFALO GROVE IL
60089-6898
US

V. Phone/Fax

Practice location:
  • Phone: 847-354-8086
  • Fax: 800-619-0893
Mailing address:
  • Phone: 847-354-8086
  • Fax: 800-619-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36104917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: