Provider Demographics
NPI:1780012344
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-933-1600
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 1:351 DELNOR DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4222
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:630-225-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTIN