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General NPI Number Information
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NPI Number | 1679993471
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Entity Type | Organization
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Legal Business Name | UIC CLINIC
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 2605 S INDIANA AVE UNIT 606
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City | CHICAGO
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State | IL
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Zip | 60616-2865
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Country | US
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Telephone | 312-504-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 S INDIANA AVE UNIT 606
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City | CHICAGO
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State | IL
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Zip | 60616-2865
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Country | US
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Telephone | 312-504-7972
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Fax |
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Authorized Official
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Title or Position | CUSTOMER SERVICE SPECIALIST
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Name | SCOTT PINKERTON
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Credential |
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Telephone | 217-333-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 018001794
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License Number State | IL
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