Provider Demographics
NPI:1922000363
Name:DUPAGE EMERGENCY PHYSICIANS CONVENIENT CARE LLC
Entity Type:Organization
Organization Name:DUPAGE EMERGENCY PHYSICIANS CONVENIENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SPILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-447-2450
Mailing Address - Street 1:PO BOX 95305
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-5305
Mailing Address - Country:US
Mailing Address - Phone:877-485-4474
Mailing Address - Fax:405-341-9217
Practice Address - Street 1:15900 127TH ST
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-2910
Practice Address - Country:US
Practice Address - Phone:630-243-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDC6381OtherRAILROAD
IL209387Medicare ID - Type Unspecified