MEDICARE: CENTRAL DUPAGE HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CF3455	OTHER		MEDICARE RR RETIREMENT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2215171	OTHER	IL	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1740313733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL DUPAGE HEALTH

Provider Business Mailing Address
First Line	:	DEPT 4003
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4698
Country	:	US
Telephone Number	:	630-462-7997
Fax Number	:	630-933-2555

Provider Business Practice Location Address
First Line	:	DEPT 4003
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-4698
Country	:	US
Telephone Number	:	630-462-7997
Fax Number	:	630-933-2555

Authorized Official
Title or Position	:	DIRECTORY LABORATORY SERVICES
Name	:	GENE HEIDT
Credential	:
Telephone Number	:	630-933-4027

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/29/2009

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Directions to “CENTRAL DUPAGE HEALTH ” Practice Location

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