MEDICARE: 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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1659431351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	2815 W WASHINGTON
Second Line	:	P O BOX 19481
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9481
Country	:	US
Telephone Number	:	217-793-2350
Fax Number	:	217-793-0773

Provider Business Practice Location Address
First Line	:	2815 W WASHINGTON
Second Line	:	SUITE 300
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9481
Country	:	US
Telephone Number	:	217-793-2350
Fax Number	:	217-793-0773

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CHARLES ONUFER
Credential	:	MD
Telephone Number	:	217-793-2350

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY OF ILLINOIS ” Practice Location

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