Healthcare Provider Details

I. General information

NPI: 1003643453
Provider Name (Legal Business Name): JOHANNA WEFES-POTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 N BARRINGTON RD
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

1555 N BARRINGTON RD
HOFFMAN ESTATES IL
60169-1019
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax:
Mailing address:
  • Phone: 813-361-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125.087442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: