MEDICARE: DUPAGE MEDICAL ASSOCIATES, SC

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	207R00000X	Internal Medicine Physician		IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD2318	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2215351	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1912968785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUPAGE MEDICAL ASSOCIATES, SC

Provider Business Mailing Address
First Line	:	303 W LAKE ST
Second Line	:	SUITE 206
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-543-4200
Fax Number	:	630-543-4037

Provider Business Practice Location Address
First Line	:	303 W LAKE ST
Second Line	:	SUITE 206
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-543-4200
Fax Number	:	630-543-4037

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS WEBB
Credential	:	M.D.
Telephone Number	:	630-543-4200

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/25/2008

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Directions to “DUPAGE MEDICAL ASSOCIATES, SC ” Practice Location

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