Provider Demographics
NPI:1669689428
Name:DUPAGE INTERNAL MEDICINE OF ILLINOIS LLC
Entity Type:Organization
Organization Name:DUPAGE INTERNAL MEDICINE OF ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PRABHU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIVALINGAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-323-7833
Mailing Address - Street 1:40 S CLAY ST STE 210W
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-8805
Mailing Address - Country:US
Mailing Address - Phone:630-323-7833
Mailing Address - Fax:630-323-7410
Practice Address - Street 1:534 CHESTNUT DR
Practice Address - Street 2:SUITE 210
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3527
Practice Address - Country:US
Practice Address - Phone:630-323-7833
Practice Address - Fax:630-323-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087760Medicaid