Provider Demographics
NPI:1003071812
Name:UNIVERSITY OF ILLINOIS AT CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS AT CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM VICE CHANCELLOR (RESEARCH)
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPHARM
Authorized Official - Phone:312-996-2862
Mailing Address - Street 1:1737 W POLK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7224
Mailing Address - Country:US
Mailing Address - Phone:312-996-2882
Mailing Address - Fax:
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-5754
Practice Address - Fax:312-355-3581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.046533282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital