1760421705 NPI number — BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

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 1760421705 NPI number — BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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:
UNIVERSITY OF ILLINOIS MEDICAL CENTER AT CHICAGO
Provider Other Organization Name Type Code:
3
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:
1760421705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 S MARSHFIELD AVE
Provider Second Line Business Mailing Address:
9TH FLOOR (M/C 732)
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-996-1000
Provider Business Mailing Address Fax Number:
312-996-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 W TAYLOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-996-7699
Provider Business Practice Location Address Fax Number:
312-996-1001
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNORR
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT, CFO, COMPTROLLER
Authorized Official Telephone Number:
312-996-8800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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