14D2132599 CLIA NUMBER - DUPAGE MEDICAL GROUP - GLENWOOD MC

Laboratory Demographics

CLIA Number: 14D2132599

Facility Name: DUPAGE MEDICAL GROUP - GLENWOOD MC

Facility Address:
10735 W 159TH ST
ORLAND PARK, IL
ZIP 60467
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Facility Phone Number: 708 873-7775

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992202535

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	14D2132599
LAB Type	Physician Office
Facility Name	DUPAGE MEDICAL GROUP - GLENWOOD MC
Street	10735 W 159TH ST
City	ORLAND PARK
State	IL
ZIP	60467
Phone	708 873-7775
CertificateType	4
CertificateEffectiveDate	6/22/2023
CertificateExpirationDate	6/21/2025
FacilityType	Waiver

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