Healthcare Provider Details

I. General information

NPI: 1760601892
Provider Name (Legal Business Name): THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

7732 SOLUTION CENTER
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAILAS SANGHANI
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 312-413-1350