Healthcare Provider Details

I. General information

NPI: 1740316074
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: 02/23/2007
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST ROOM 163
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST SUITE 345 CSB, MC 884
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6887
  • Fax: 312-355-1916
Mailing address:
  • Phone: 312-355-2035
  • Fax: 312-355-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number93007836
License Number StateIL

VIII. Authorized Official

Name: WALTER K KNORR
Title or Position: VICE PRESIDENT, CFO, COMPTROLLER
Credential:
Phone: 312-996-8800