# CRYSTAL LAKE FOOT & ANKLE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649986795
- **Authorized official:** DR. PAUL POTACH D.P.M. (OWNER)
- **Authorized official phone:** (815) 477-9221

## Contact information

- **Practice address:** 39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
- **Practice address phone:** (815) 477-9221
- **Mailing address:** 39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
- **Mailing address phone:** (815) 477-9221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 01/23/2023
- **Last updated:** 05/16/2023