Individual
DEREK WILLIAM POTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
226 W ONTARIO ST, CHICAGO, IL 60654-3619
(312) 912-7008
Mailing address
226 W ONTARIO ST, CHICAGO, IL 60654-3619
(312) 912-7008
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144295722
—
IL
Enumeration date
01/18/2022
Last updated
01/18/2022
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