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General NPI Number Information
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NPI Number | 1609822147
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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 | 05/26/2006
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 912 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 312-413-3783
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Fax | 312-996-3514
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Provider Business Mailing Address
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Address Line | 7825 SOLUTION CENTER
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City | CHICAGO
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State | IL
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Zip | 60677-7008
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Country | US
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Telephone | 312-996-7383
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Fax | 312-996-3514
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICIAN PRACTICE
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Name | MS. SUNITA PRABHAKAR
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Credential | MS, CPC
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Telephone | 312-413-3783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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