Healthcare Provider Details

I. General information

NPI: 1538735972
Provider Name (Legal Business Name): DUPAGE MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 W 95TH ST STE 6
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: 630-790-1872
  • Fax: 708-229-0090
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