| The Board Of Trustees Of The University Of Illinois | |
|
835 S. Wolcott Suite E-144; Mc 684 Chicago IL 60612 | |
| (312) 996-7420 | |
| (312) 413-8485 |
| Full Name | The Board Of Trustees Of The University Of Illinois |
|---|---|
| Speciality | Preventive Medicine - Occupational Medicine |
| Location | 835 S. Wolcott, Chicago, Illinois |
| Authorized Official Name and Position | Daniel A Bakston (INTERIM DIRECTOR) |
| Authorized Official Contact | 3123553554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Board Of Trustees Of The University Of Illinois 7732 Solutions Center Chicago IL 60677-7007 Ph: (312) 413-0369 | The Board Of Trustees Of The University Of Illinois 835 S. Wolcott Suite E-144; Mc 684 Chicago IL 60612 Ph: (312) 996-7420 |
| NPI Number | 1043727571 |
|---|---|
| Provider Enumeration Date | 01/05/2018 |
| Last Update Date | 07/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043727571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 2083X0100X | Preventive Medicine - Occupational Medicine | (* (Not Available)) | Primary |
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