MEDICARE: BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0002X	Clinic Pharmacy	054-017119	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054-017119	OTHER	IL	STATE LICENSE
2	032-006004	OTHER	IL	STATE CONTROLLED SUBSTANC
3	1453391	OTHER	IL	NCPDP NUMBER

General Provider Information

NPI Number	:	1528109170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	840 S WOOD ST
Second Line	:	ROOM 345H MC 884
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-355-2035
Fax Number	:	312-355-1916

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST
Second Line	:	ROOM 309 MC 884
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-996-8675
Fax Number	:	312-355-1916

Authorized Official
Title or Position	:	PHARMACY TECHNICIAN SPECIALIST
Name	:	MS. KRISTINE D VANKUIKEN
Credential	:
Telephone Number	:	312-355-2035

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	03/07/2023

Similar Medicare Providers

1992790828 — JULIA CORCORAN MD
Practice Location Address:

1801 W TAYLOR ST , 3F OCC MC 741
CHICAGO, IL
60612-4795

Practice Phone: 312-996-9313
Practice Fax:

1134115231 — ALEJANDRA PEREZ-TAMAYO MD
Practice Location Address:

1801 W TAYLOR ST , 3F-OCC
CHICAGO, IL
60612-4795

Practice Phone: 312-996-6883
Practice Fax: 312-413-1206

1558341677 — RADHIKA SREEDHAR M.D., M.S.
Practice Location Address:

1801 W TAYLOR ST , 3AA
CHICAGO, IL
60612-4795

Practice Phone: 312-413-3627
Practice Fax:

1083689137 — DR. MARIA MAGDALENE TSOUKAS M.D., PH.D.
Practice Location Address:

1801 W TAYLOR ST STE 3E
CHICAGO, IL
60612-4795

Practice Phone: 312-413-7448
Practice Fax: 312-996-1188

1326014077 — DR. IRENE EFTEKHAR M.D.
Practice Location Address:

1801 W TAYLOR ST STE 2E
CHICAGO, IL
60612-4795

Practice Phone: 312-996-7416
Practice Fax: 312-413-8778

1851357388 — DR. LEWIS LI-YEN HSU M.D., PH.D.
Practice Location Address:

1801 W TAYLOR ST , SUITE 2E
CHICAGO, IL
60612-4795

Practice Phone: 312-996-6143
Practice Fax: 312-413-9484

1699722777 — MIN J JOO MD
Practice Location Address:

1801 W TAYLOR ST , 3C
CHICAGO, IL
60612-4795

Practice Phone: 312-996-3300
Practice Fax: 312-996-3896

Directions to “BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.