Berwyn Foot & Ankle Center

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

016004088 Issued in IL

Legal business name

BERWYN FOOT & ANKLE CENTER

Practice address

3100 South Oak Park Ave
Berwyn, IL 60402-3031

Phone

(708) 484-3338

Fax

(708) 484-2059

NPI assigned

May 19, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul Potach, DPM

Title

President

Phone

(708) 484-3338

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252022400000",
    "number": "1346407301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SOUTH OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023031",
            "telephone_number": "708-484-3338",
            "fax_number": "708-484-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SOUTH OAK PARK AVE",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023031",
            "telephone_number": "708-484-3338",
            "fax_number": "708-484-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERWYN FOOT & ANKLE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2009-09-04",
        "status": "A",
        "authorized_official_last_name": "POTACH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-484-3338",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "IL",
            "license": "016004088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Berwyn Emergency Services SC
• Berwyn Family Dental
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• Berwyn Imaging LLC
• Berwyn Magnetic Resonance Center LLC
• Berwyn Magnetic Resonance Center LLC
• Berwyn Oak Park Family Dentistry
• Berwyn Orthopedic Surgeons, LTD.

• Podiatric Clinic/Center in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Podiatric Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.