Provider Demographics
NPI:1982879029
Name:DUPAGE HEALTH CENTER LTD
Entity Type:Organization
Organization Name:DUPAGE HEALTH CENTER LTD
Other - Org Name:PEJOMA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:NASIR
Authorized Official - Last Name:GHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-219-7396
Mailing Address - Street 1:206 N GARY AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1834
Mailing Address - Country:US
Mailing Address - Phone:847-219-7396
Mailing Address - Fax:
Practice Address - Street 1:206 N GARY AVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1834
Practice Address - Country:US
Practice Address - Phone:847-219-7396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-111607207Q00000X, 207R00000X, 208D00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111607OtherMEDICAL LICENSE NUMBER