Provider Demographics
NPI:1043699309
Name:DUPAGE MEDICAL GROUP, LTD
Entity Type:Organization
Organization Name:DUPAGE MEDICAL GROUP, LTD
Other - Org Name:DUPAGE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-790-1221
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:651 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8169
Practice Address - Country:US
Practice Address - Phone:630-967-2000
Practice Address - Fax:630-547-8001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUPAGE MEDICAL GROUP, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042000124332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL785110OtherMEDICARE GROUP PTAN
IL205994OtherMEDICARE GROUP PTAN