Healthcare Provider Details

I. General information

NPI: 1356822993
Provider Name (Legal Business Name): WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 CROSS ST STE 180
SHILOH IL
62269-2965
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-8200
  • Fax:
Mailing address:
  • Phone: 314-747-2611
  • Fax: 314-362-4969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHY EGHIGIAN
Title or Position: SENIOR DIRECTOR MANAGED CARE
Credential:
Phone: 314-273-0770