Provider Demographics
NPI:1730141631
Name:DUPAGE PLASTIC SURGERY, LTD
Entity Type:Organization
Organization Name:DUPAGE PLASTIC SURGERY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BULL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-717-6000
Mailing Address - Street 1:1307 MACOM DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-3202
Mailing Address - Country:US
Mailing Address - Phone:630-717-6000
Mailing Address - Fax:630-717-6777
Practice Address - Street 1:1307 MACOM DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-3202
Practice Address - Country:US
Practice Address - Phone:630-717-6000
Practice Address - Fax:630-717-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102621208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
212729Medicare ID - Type Unspecified