Healthcare Provider Details

I. General information

NPI: 1780623710
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: 06/05/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

7712 SOLUTION CENTER
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax: 312-996-1001
Mailing address:
  • Phone: 312-996-1000
  • Fax: 312-996-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BENJAMIN ZENN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 312-996-3620