Provider Demographics
NPI:1487876686
Name:DUPAGE NEUROSURGERY SC
Entity type:Organization
Organization Name:DUPAGE NEUROSURGERY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-858-5400
Mailing Address - Street 1:2001 N GARY AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3055
Mailing Address - Country:US
Mailing Address - Phone:630-858-5400
Mailing Address - Fax:630-858-4950
Practice Address - Street 1:2001 N GARY AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-858-5400
Practice Address - Fax:630-858-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL707160Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER