Healthcare Provider Details

I. General information

NPI: 1164422283
Provider Name (Legal Business Name): LESTER EDWARD POTEMPA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD 132
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

22255 GREENFIELD RD STE 300
SOUTHFIELD MI
48075-3729
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax: 248-849-5378
Mailing address:
  • Phone: 248-746-0342
  • Fax: 248-746-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101009556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: