1285628057 NPI number — DUPAGE HEALTH SPECIALISTS SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285628057 NPI number — DUPAGE HEALTH SPECIALISTS SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUPAGE HEALTH SPECIALISTS SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285628057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3033 OGDEN AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-1673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-717-5700
Provider Business Mailing Address Fax Number:
630-717-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3033 OGDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LISLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60532-1673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-717-5700
Provider Business Practice Location Address Fax Number:
630-717-0665
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HSIA
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATION PRESIDENT
Authorized Official Telephone Number:
630-717-5700

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  042616680 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com