Healthcare Provider Details

I. General information

NPI: 1831433291
Provider Name (Legal Business Name): CENTRAL DUPAGE PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S IL ROUTE 59 SUITE 320
BARTLETT IL
60103-1694
US

IV. Provider business mailing address

5777 DEPARTMENT
CAROL STREAM IL
60122-5777
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-2663
  • Fax:
Mailing address:
  • Phone: 630-933-3300
  • Fax: 630-933-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBI TAPANES
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 630-933-1616