MEDICARE: THE 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
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
2	2084N0600X	Clinical Neurophysiology Physician
3	2084P0005X	Neurodevelopmental Disabilities Physician
4	2084V0102X	Vascular Neurology Physician
5	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG2991	OTHER	IL	RAILROAD GROUP
2	01618716	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1982824660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

Provider Business Mailing Address
First Line	:	7732 SOLUTION CENTER
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4300
Country	:	US
Telephone Number	:	312-996-6496
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	KAILAS SANGHANI
Credential	:
Telephone Number	:	312-413-1350

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/21/2023

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

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