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General NPI Number Information
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NPI Number | 1578724753
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS URBANA-CHAMPAIGN
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1109 S LINCOLN AVE MC-026
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City | URBANA
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State | IL
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Zip | 61801-4703
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Country | US
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Telephone | 217-333-2711
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Fax | 217-244-1758
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Provider Business Mailing Address
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Address Line | 1109 S LINCOLN AVE MC-026
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City | URBANA
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State | IL
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Zip | 61801-4703
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Country | US
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Telephone | 217-333-2711
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Fax | 217-244-1758
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, MCKINLEY HEALTH
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Name | AWAIS VAID
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Credential |
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Telephone | 217-333-2711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 036105311
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License Number State | IL
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