MEDICARE: DR. ALEXANDER V. POTERMIN M.D.

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	207Q00000X	Family Medicine Physician	36104917	IL

General Provider Information

NPI Number	:	1407842958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER V. POTERMIN M.D.

Provider Business Mailing Address
First Line	:	1444 DOWNING PL APT M5
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4343
Country	:	US
Telephone Number	:	847-354-8086
Fax Number	:	800-619-0893

Provider Business Practice Location Address
First Line	:	1444 DOWNING PL APT M5
Second Line	:
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4343
Country	:	US
Telephone Number	:	847-354-8086
Fax Number	:	800-619-0893

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/19/2025

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