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General NPI Number Information
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NPI Number | 1760421705
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Entity Type | Organization
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Legal Business Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-7699
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Fax | 312-996-1001
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Provider Business Mailing Address
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Address Line | 809 S MARSHFIELD AVE 9TH FLOOR (M/C 732)
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City | CHICAGO
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State | IL
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Zip | 60612-4305
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Country | US
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Telephone | 312-996-1000
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Fax | 312-996-1001
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Authorized Official
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Title or Position | VICE PRESIDENT, CFO, COMPTROLLER
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Name | WALTER K KNORR
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Credential |
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Telephone | 312-996-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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