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General NPI Number Information
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NPI Number | 1407307812
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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 | 10/20/2016
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1640 W ROOSEVELT RD ROOM 336
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City | CHICAGO
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State | IL
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Zip | 60608-1316
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Country | US
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Telephone | 312-413-8043
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Fax |
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Provider Business Mailing Address
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Address Line | 5254 SOLUTION CENTER
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 312-996-4404
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Fax |
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Authorized Official
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Title or Position | DEAN, APPLIED HEALTH SCIENCES
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Name | DR. BO FERNHALL
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Credential | PH.D.
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Telephone | 312-996-6695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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