Provider Demographics
NPI:1033467857
Name:UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENCRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MA, FACP
Authorized Official - Phone:217-383-3110
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:CARLE FORUM, LL
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-3110
Mailing Address - Fax:217-244-0621
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:CARLE FORUM, LL
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2500
Practice Address - Country:US
Practice Address - Phone:217-383-3110
Practice Address - Fax:217-244-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060935282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital