Healthcare Provider Details

I. General information

NPI: 1023830668
Provider Name (Legal Business Name): DPMS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE STE 2800
OAK PARK IL
60304-1092
US

IV. Provider business mailing address

610 S MAPLE AVE STE 2800
OAK PARK IL
60304-1092
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-4120
  • Fax:
Mailing address:
  • Phone: 312-563-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIPEN PATEL
Title or Position: PRESIDENT
Credential:
Phone: 773-329-0281