Healthcare Provider Details

I. General information

NPI: 1578091971
Provider Name (Legal Business Name): THE BOARD OF TRUSTEE FOR THE UNIVERSITY OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WEST O'HARE TERMINAL 2
CHICAGO IL
60660-0508
US

IV. Provider business mailing address

7732 SOLUTION CTR
CHICAGO IL
60677-7007
US

V. Phone/Fax

Practice location:
  • Phone: 773-894-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RHEA BEGEMAN
Title or Position: DIRECTOR ADMINISTRATIVE OPERATIONS
Credential:
Phone: 312-413-0002