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General NPI Number Information
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NPI Number | 1659704708
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Entity Type | Organization
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Legal Business Name | DUPAGE MEDICAL GROUP LTD
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 133 E BRUSH HILL RD STE 100
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City | ELMHURST
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State | IL
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Zip | 60126-5659
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Country | US
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Telephone | 630-501-0630
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 713260
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City | CHICAGO
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State | IL
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Zip | 60677-1260
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Country | US
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Telephone | 630-469-9200
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | PAUL MERRICK
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Credential | MD
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Telephone | 630-790-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 042000124
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License Number State | IL
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