14D0421017 CLIA NUMBER - DUPAGE MED GROUP D/B/A GENERAL PEDIATRICS

Laboratory Demographics

CLIA Number: 14D0421017

Facility Name: DUPAGE MED GROUP D/B/A GENERAL PEDIATRICS

Facility Address:
5207 MAIN ST - STE 1A
DOWNERS GROVE, IL
ZIP 60515
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Facility Phone Number: 630 964-6049

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073010245

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D0421017
LAB Type	Physician Office
Facility Name	DUPAGE MED GROUP D/B/A GENERAL PEDIATRICS
Street	5207 MAIN ST - STE 1A
City	DOWNERS GROVE
State	IL
ZIP	60515
Phone	630 964-6049
CertificateType	4
CertificateEffectiveDate	3/17/2023
CertificateExpirationDate	3/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024