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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1622185	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1720555147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	1220 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1202
Country	:	US
Telephone Number	:	312-413-1261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 W 39TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2402
Country	:	US
Telephone Number	:	312-413-1261
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. HENRY TAYLOR
Credential	:
Telephone Number	:	312-413-1261

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	10/25/2018

Similar Medicare Providers

1194851121 — DR. ARIN STONE PSY.D.
Practice Location Address:

3050 W 39TH PL
CHICAGO, IL
60632-2402

Practice Phone: 312-413-3039
Practice Fax:

1932450160 — THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Practice Location Address:

3050 W 39TH PL
CHICAGO, IL
60632-2402

Practice Phone: 312-413-1261
Practice Fax: 312-413-7812

1588676944 — EDMUND J LEWIS M D & ASSOCIATES
Practice Location Address:

104 S ASHLAND AVE
CHICAGO, IL
60607-2402

Practice Phone: 312-850-8434
Practice Fax: 312-829-3887

1467438630 — DR. STEVEN J DEANGELES MD
Practice Location Address:

200 S MICHIGAN AVE , SUITE 830
CHICAGO, IL
60604-2402

Practice Phone: 312-922-2500
Practice Fax: 312-922-2523

1104802370 — STEVEN J. DEANGELES, M.D., S.C.
Practice Location Address:

200 S MICHIGAN AVE , SUITE 830
CHICAGO, IL
60604-2402

Practice Phone: 312-922-2500
Practice Fax: 312-922-2523

1952369563 — DR. SHIRLEY LEE TERMOLEN M.D.
Practice Location Address:

200 S MICHIGAN AVE , SUITE 805
CHICAGO, IL
60604-2402

Practice Phone: 312-922-3815
Practice Fax: 312-922-7449

Directions to “BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.