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General NPI Number Information
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NPI Number | 1700332392
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Entity Type | Organization
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Legal Business Name | NORTHERN ILLINOIS UNIVERSITY
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1425 W LINCOLN HWY CONVOCATION CENTER
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City | DEKALB
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State | IL
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Zip | 60115-2828
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Country | US
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Telephone | 815-753-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 W. LINCOLN WAY HWY NIU SPORTS MEDICINE CONVOCATION CENTER SUITE 170
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City | DEKALB
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State | IL
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Zip | 60115-2828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE ATHLETIC DIRECTOR
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Name | PHIL VOORHIS III
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Credential | LAT MSED.
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Telephone | 815-753-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.08668
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License Number State | IL
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