MEDICARE: BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1336085299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	1740 W TAYLOR
Second Line	:	HOSPITAL ADMIN MAILCODE 693
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 S WOOD ST RM 1047
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1202
Country	:	US
Telephone Number	:	312-996-3620
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	LAURENCE APPEL
Credential	:
Telephone Number	:	312-996-3620

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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