MEDICARE: COURTNEY POTEMPA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085002257	IL

General Provider Information

NPI Number	:	1265405021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY POTEMPA PA-C

Provider Business Mailing Address
First Line	:	4311 N SHERIDAN RD APT 300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5465
Country	:	US
Telephone Number	:	630-854-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2432
Country	:	US
Telephone Number	:	773-549-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	06/05/2019

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