Provider Demographics
NPI:1740313733
Name:CENTRAL DUPAGE HEALTH
Entity type:Organization
Organization Name:CENTRAL DUPAGE HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTORY LABORATORY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-933-4027
Mailing Address - Street 1:DEPT 4003
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4698
Mailing Address - Country:US
Mailing Address - Phone:630-462-7997
Mailing Address - Fax:630-933-2555
Practice Address - Street 1:DEPT 4003
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60122-4698
Practice Address - Country:US
Practice Address - Phone:630-462-7997
Practice Address - Fax:630-933-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2215171OtherBLUE CROSS GROUP NUMBER
CF3455OtherMEDICARE RR RETIREMENT
CF3455OtherMEDICARE RR RETIREMENT
CF3455OtherMEDICARE RR RETIREMENT