Organization
DUPAGE MEDICAL GROUP LTD
Active
Other names
DuPage Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MERRICK MD (PRESIDENT, BOARD OF DIRECTORS)
(630) 790-1221
Entity
Organization
Contact information
Practice address
1100 W 31ST ST, STE 300, DOWNERS GROVE, IL 60515-5509
(630) 469-9200
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
042000124
IL
332B00000X
Durable Medical Equipment & Medical Supplies
042000124
IL
332H00000X
Eyewear Supplier
042000124
IL
333600000X
Pharmacy
054018228
IL
3336C0002X
Clinic Pharmacy
054018228
IL
3336C0003X
Community/Retail Pharmacy
054018228
IL
335E00000X
Prosthetic/Orthotic Supplier
042000124
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200502
MEDICARE GROUP NUMBER
IL
01
—
205994
MEDICARE GROUP NUMBER
IL
01
—
568660
MEDICARE GROUP NUMBER
IL
01
—
569810
MEDICARE GROUP NUMBER
IL
01
—
584330
MEDICARE GROUP NUMBER
IL
01
—
785110
PTAN
IL
Enumeration date
05/31/2006
Last updated
08/24/2023
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