Healthcare Provider Details

I. General information

NPI: 1245335892
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: 09/14/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 W HARRISON ST SUITE 104
CHICAGO IL
60612-3515
US

IV. Provider business mailing address

6114 PAYSPHERE CIR
CHICAGO IL
60674-0061
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7708
  • Fax: 312-413-0503
Mailing address:
  • Phone: 312-996-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER K KNORR
Title or Position: CONTROLLER
Credential:
Phone: 312-996-2862