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General NPI Number Information
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NPI Number | 1346596327
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Entity Type | Organization
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Legal Business Name | THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 641 W. 63RD ST UIH-MILE SQUARE HEALTH CENTER AT ENGLEWOOD
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 312-413-4070
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Fax | 312-413-7812
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Provider Business Mailing Address
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Address Line | 1220 S. WOOD STREET UIH-MILE SQUARE HEALTH CENTER
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City | CHICAGO
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State | IL
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Zip | 60608-1202
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Country | US
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Telephone | 312-413-1261
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Fax | 312-413-7812
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Authorized Official
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Title or Position | CFO
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Name | MR. TIMOTHY STECKER
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Credential |
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Telephone | 312-355-7653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | IL
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