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General NPI Number Information
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NPI Number | 1316441231
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Entity Type | Individual
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Provider Name | JOSHUA JEREMY POTHEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-9000
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Fax | 352-401-8313
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Provider Business Mailing Address
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Address Line | 1431 SW 1ST AVE STE 7
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City | OCALA
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State | FL
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Zip | 34471-6500
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Country | US
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Telephone | 352-401-8311
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Fax | 352-401-8313
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 036161230
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License Number State | IL
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