Provider Demographics
NPI:1356644595
Name:CENTRAL DUPAGE HEALTH
Entity Type:Organization
Organization Name:CENTRAL DUPAGE HEALTH
Other - Org Name:NW MEDICINE CONVENIENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:952-653-2568
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:952-653-2568
Mailing Address - Fax:
Practice Address - Street 1:885 ROOSEVELT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6168
Practice Address - Country:US
Practice Address - Phone:630-384-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL DUPAGE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-09
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site