Healthcare Provider Details

I. General information

NPI: 1801833983
Provider Name (Legal Business Name): DUPAGE MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W 31ST ST STE 300
DOWNERS GROVE IL
60515-5509
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-9200
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number042000124
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number042000124
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number042000124
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054018228
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number054018228
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054018228
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number042000124
License Number StateIL

VIII. Authorized Official

Name: PAUL MERRICK
Title or Position: PRESIDENT, BOARD OF DIRECTORS
Credential: MD
Phone: 630-790-1221