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General NPI Number Information
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NPI Number | 1659431351
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2815 W WASHINGTON SUITE 300
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9481
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Country | US
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Telephone | 217-793-2350
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Fax | 217-793-0773
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Provider Business Mailing Address
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Address Line | 2815 W WASHINGTON P O BOX 19481
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9481
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Country | US
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Telephone | 217-793-2350
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Fax | 217-793-0773
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHARLES ONUFER
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Credential | MD
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Telephone | 217-793-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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