Healthcare Provider Details

I. General information

NPI: 1275117145
Provider Name (Legal Business Name): DU PAGE MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 W 95TH ST STE 1
OAK LAWN IL
60453-2611
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-2000
  • Fax: 630-348-3942
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 Number
License Number State

VIII. Authorized Official

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