Organization
CRYSTAL LAKE FOOT & ANKLE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL POTACH D.P.M. (OWNER)
(815) 477-9221
Entity
Organization
Contact information
Practice address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
Mailing address
39 S VIRGINIA ST, CRYSTAL LAKE, IL 60014-5826
(815) 477-9221
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
01/23/2023
Last updated
05/16/2023
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