Provider Demographics
NPI:1801833983
Name:DUPAGE MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:DUPAGE MEDICAL GROUP LTD
Other - Org Name:DUPAGE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-790-1221
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1100 W 31ST ST
Practice Address - Street 2:STE 300
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5509
Practice Address - Country:US
Practice Address - Phone:630-469-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042000124261QM1300X, 332B00000X, 332H00000X, 335E00000X
IL054018228333600000X, 3336C0002X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL568660OtherMEDICARE GROUP NUMBER
IL785110OtherPTAN
IL200502OtherMEDICARE GROUP NUMBER
IL584330OtherMEDICARE GROUP NUMBER
IL205994OtherMEDICARE GROUP NUMBER
IL569810OtherMEDICARE GROUP NUMBER
IL584330OtherMEDICARE GROUP NUMBER
IL6180250007Medicare NSC
IL6180250008Medicare NSC
IL6180250014Medicare NSC
IL6180250042Medicare NSC
IL6180250011Medicare NSC
IL6180250012Medicare NSC
IL6180250025Medicare NSC
IL6180250027Medicare NSC
IL6180250003Medicare NSC
IL6180250013Medicare NSC
IL6180250024Medicare NSC
IL6180250016Medicare NSC
IL6180250020Medicare NSC
IL6180250026Medicare NSC
IL569810OtherMEDICARE GROUP NUMBER
IL785110OtherPTAN
IL6180250010Medicare NSC
IL6180250017Medicare NSC
IL6180250005Medicare NSC
IL6180250002Medicare NSC
IL205994OtherMEDICARE GROUP NUMBER
IL6180250009Medicare NSC
IL6180250015Medicare NSC
IL6180250019Medicare NSC
IL6180250021Medicare NSC
IL6180250023Medicare NSC
IL6180250006Medicare NSC
IL6180250001Medicare NSC