Organization
DUPAGE MEDICAL GROUP, LTD
Active
Other names
Dupage Medical Group, Ltd
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MERRICK MD (CHAIRMAN OF THE BOARD)
(630) 790-1221
Entity
Organization
Contact information
Practice address
2320 HIGH ST, BLUE ISLAND, IL 60406-2426
(708) 388-5500
(708) 388-5672
Mailing address
2320 HIGH ST, ADMINISTRATION, BLUE ISLAND, IL 60406-2426
(708) 388-5500
(708) 226-7170
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621031
BCBS PROVIDER ID
IL
01
—
CD5640
RAILROAD MEDICARE
IL
01
—
IL3596
LOCALITY15 MEDICARE
IL
Enumeration date
05/18/2006
Last updated
10/13/2023
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