Provider Demographics
NPI:1063387173
Name:PAUL POTACH D.P.M.,P.C.
Entity type:Organization
Organization Name:PAUL POTACH D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:POTACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-215-1525
Mailing Address - Street 1:31 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4863
Mailing Address - Country:US
Mailing Address - Phone:847-215-1525
Mailing Address - Fax:847-215-7682
Practice Address - Street 1:31 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-4863
Practice Address - Country:US
Practice Address - Phone:847-215-1525
Practice Address - Fax:847-215-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty