Healthcare Provider Details

I. General information

NPI: 1013152537
Provider Name (Legal Business Name): DUPAGE MEDICAL GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 10/12/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 W 127TH ST 225
PLAINFIELD IL
60585-9507
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 TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number042000124
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number042000124
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier785110
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerMEDICARE GROUP NUMBER

VIII. Authorized Official

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