| Board Of Trustees Of The University Of Illinois | |
|
1601 Parkview Ave Rockford IL 61107-1822 | |
| (815) 395-5637 | |
| (815) 395-5887 |
| Full Name | Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Family Medicine |
| Location | 1601 Parkview Ave, Rockford, Illinois |
| Authorized Official Name and Position | Uma Sriram (DIRECTOR OF FISCAL AFFAIRS) |
| Authorized Official Contact | 8153955637 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Board Of Trustees Of The University Of Illinois 1601 Parkview Ave Rockford IL 61107-1822 Ph: (815) 395-5637 | Board Of Trustees Of The University Of Illinois 1601 Parkview Ave Rockford IL 61107-1822 Ph: (815) 395-5637 |
| NPI Number | 1003218348 |
|---|---|
| Provider Enumeration Date | 09/18/2014 |
| Last Update Date | 04/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003218348 | NPI | - | NPPES |
| PENDING | Medicaid | IL |
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