Individual
STEVEN G POTACZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3315 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 344-1000
(309) 344-1054
Mailing address
3315 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 344-1000
(309) 344-1054
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036076331
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076331
—
IL
01
—
10595759
CAQH
IL
01
—
364271985-36
JOHN DEERE
—
01
—
4314340
AETNA
—
01
—
4815127
BC/BS
—
Enumeration date
09/26/2006
Last updated
02/05/2015
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