Provider Demographics
NPI:1043727571
Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other - Org Name:OCCUPATIONAL HEALTH SERVICE INSTITUTE (OHSI)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MBA
Authorized Official - Phone:312-355-3554
Mailing Address - Street 1:7732 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7007
Mailing Address - Country:US
Mailing Address - Phone:312-413-0369
Mailing Address - Fax:312-413-8485
Practice Address - Street 1:835 S. WOLCOTT
Practice Address - Street 2:SUITE E-144; MC 684
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-7420
Practice Address - Fax:312-413-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty