Organization
DUPAGE MEDICAL GROUP, LTD
Active
Other names
High Street Pharmacy
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 STREET, BLUE ISLAND, IL 60406
(708) 388-0033
(708) 388-0257
Mailing address
430 WARRENVILLE ROAD, SUITE # 215, LISLE, IL 60532
(708) 388-0033
(708) 388-0257
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
0054005063
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001671073
BC BS OF IL
IL
05
—
362757948001
—
IL
Enumeration date
11/28/2006
Last updated
10/13/2023
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