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General NPI Number Information
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NPI Number | 1992925580
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Entity Type | Organization
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Legal Business Name | ILLINOIS DEPARTMENT OF PUBLIC HEALTH
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 825 N RUTLEDGE ST
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City | SPRINGFIELD
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State | IL
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Zip | 62702-4910
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Country | US
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Telephone | 217-782-6562
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Fax | 217-524-7924
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Provider Business Mailing Address
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Address Line | 535 W JEFFERSON ST 5TH FLOOR
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City | SPRINGFIELD
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State | IL
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Zip | 62761-0001
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Country | US
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Telephone | 217-782-4977
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Fax | 217-782-3987
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ERIC E. WHITAKER
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Credential | M.D., MPH
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Telephone | 312-814-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | IL
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