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General NPI Number Information
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NPI Number | 1376586206
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Entity Type | Organization
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Legal Business Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1601 PARKVIEW AVE
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City | ROCKFORD
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State | IL
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Zip | 61107-1822
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Country | US
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Telephone | 815-395-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 PARKVIEW AVE S300
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City | ROCKFORD
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State | IL
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Zip | 61107-1822
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Country | US
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Telephone | 815-395-5892
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Fax | 815-395-5644
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT ACCOUNTS
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Name | JOHN FITZHORN
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Credential |
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Telephone | 815-395-5892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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