Provider Demographics
NPI:1164894465
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:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:MAYEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-287-5711
Mailing Address - Street 1:835 S WOLCOTT AVE
Mailing Address - Street 2:E 270
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3748
Mailing Address - Country:US
Mailing Address - Phone:312-996-7161
Mailing Address - Fax:
Practice Address - Street 1:835 S WOLCOTT AVE
Practice Address - Street 2:E 270
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-996-7161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059887282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital