Provider Demographics
NPI:1275817249
Name:UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JOKELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-383-3110
Mailing Address - Street 1:2522 FIELDS SOUTH DR
Mailing Address - Street 2:APT NO 206
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3709
Mailing Address - Country:US
Mailing Address - Phone:404-697-0663
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:CARLE FORUM
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128060282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital