| Board Of Trustees Of The University Of Illinois | |
|
912 S Wood St Chicago IL 60612-4300 | |
| (312) 355-1000 | |
| Not Available |
| Full Name | Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Psychologist |
| Location | 912 S Wood St, Chicago, Illinois |
| Authorized Official Name and Position | Kailas Sanghani (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 3123556468 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of The University Of Illinois 7732 Solutions Center Chicago IL 60677-7007 Ph: (312) 355-6468 | Board Of Trustees Of The University Of Illinois 912 S Wood St Chicago IL 60612-4300 Ph: (312) 355-1000 |
| NPI Number | 1316537889 |
|---|---|
| Provider Enumeration Date | 01/19/2021 |
| Last Update Date | 02/04/2021 |
| Certification Date | 02/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316537889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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