Individual
DR. JULIE POTZICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
25 N WINFIELD, WINFIELD, IL 60190-1295
(630) 933-1600
Mailing address
25 N WINFIELD, WINFIELD, IL 60190-1295
(630) 933-1600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036095357
IL
208D00000X
General Practice Physician
36-95357
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03609537
—
IL
01
—
820800
MEDICARE PTAN (GROUP)
IL
01
—
920540034
MEDICARE PTAN
IL
01
—
F400127982
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
01/31/2006
Last updated
04/16/2014
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