Healthcare Provider Details

I. General information

NPI: 1659501500
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: 07/24/2009
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S PAULINA ST 118 DENT, MC 588
CHICAGO IL
60612-4353
US

IV. Provider business mailing address

1740 W TAYLOR ST # MC693
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6933
  • Fax: 312-355-4173
Mailing address:
  • Phone: 312-996-3620
  • Fax: 312-996-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. LAURENCE APPEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 312-996-3620