14D2091607 CLIA NUMBER - DUPAGE MEDICAL GROUP IM/PEDS

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Laboratory Demographics

CLIA Number: 14D2091607

Facility Name: DUPAGE MEDICAL GROUP IM/PEDS

Facility Address:
1801 S HIGHLAND AVE, STE 130
LOMBARD, IL
ZIP 60148
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Facility Phone Number: 630 627-4722

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770721151

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	14D2091607
LAB Type	Physician Office
Facility Name	DUPAGE MEDICAL GROUP IM/PEDS
Street	1801 S HIGHLAND AVE, STE 130
City	LOMBARD
State	IL
ZIP	60148
Phone	630 627-4722
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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