Healthcare Provider Details

I. General information

NPI: 1659704708
Provider Name (Legal Business Name): DUPAGE MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E BRUSH HILL RD STE 100
ELMHURST IL
60126-5659
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-501-0630
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number042000124
License Number StateIL

VIII. Authorized Official

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