Provider Demographics
NPI:1003010554
Name:FAMILY DOCTOR'S OF DUPAGE, S.C.
Entity Type:Organization
Organization Name:FAMILY DOCTOR'S OF DUPAGE, S.C.
Other - Org Name:ADVANCED INTEGRATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:EPPERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-893-9661
Mailing Address - Street 1:245 S GARY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2228
Mailing Address - Country:US
Mailing Address - Phone:630-893-9661
Mailing Address - Fax:630-893-5665
Practice Address - Street 1:245 S GARY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2228
Practice Address - Country:US
Practice Address - Phone:630-893-9661
Practice Address - Fax:630-893-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC46238Medicare UPIN