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General NPI Number Information
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NPI Number | 1801963855
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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 | 11/28/2006
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 2320 HIGH STREET
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City | BLUE ISLAND
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State | IL
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Zip | 60406
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Country | US
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Telephone | 708-388-0033
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Fax | 708-388-0257
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Provider Business Mailing Address
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Address Line | 430 WARRENVILLE ROAD SUITE # 215
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City | LISLE
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State | IL
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Zip | 60532
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Country | US
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Telephone | 708-388-0033
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Fax | 708-388-0257
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0054005063
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License Number State | IL
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