Healthcare Provider Details

I. General information

NPI: 1336316942
Provider Name (Legal Business Name): PAUL POTACH D.P.M. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W DUNDEE RD
WHEELING IL
60090-4863
US

IV. Provider business mailing address

31 WEST DUNDEE RD
WHEELING IL
60090-4863
US

V. Phone/Fax

Practice location:
  • Phone: 847-215-1525
  • Fax:
Mailing address:
  • Phone: 847-215-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number016-004088
License Number StateIL

VIII. Authorized Official

Name: DR. PAUL POTACH
Title or Position: PRESIDENT
Credential: DPM
Phone: 847-215-1525