Healthcare Provider Details

I. General information

NPI: 1700839230
Provider Name (Legal Business Name): DUPAGE MEDICAL GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HIGH ST
BLUE ISLAND IL
60406-2426
US

IV. Provider business mailing address

2320 HIGH ST ADMINISTRATION
BLUE ISLAND IL
60406-2426
US

V. Phone/Fax

Practice location:
  • Phone: 708-388-5500
  • Fax: 708-388-5672
Mailing address:
  • Phone: 708-388-5500
  • Fax: 708-226-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL MERRICK
Title or Position: CHAIRMAN OF THE BOARD
Credential: MD
Phone: 630-790-1221