Provider Demographics
NPI:1477897833
Name:CENTRAL DUPAGE PHYSICIAN GROUP
Entity Type:Organization
Organization Name:CENTRAL DUPAGE PHYSICIAN GROUP
Other - Org Name:NORTHWESTERN MEDICINE REGIONAL MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-933-1616
Mailing Address - Street 1:5777 DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-5777
Mailing Address - Country:US
Mailing Address - Phone:630-933-3300
Mailing Address - Fax:630-933-2740
Practice Address - Street 1:885 ROOSEVELT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6141
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-23
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty