Provider Demographics
NPI:1326345844
Name:UNIVERSITY OF ILINOIS AT CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF ILINOIS AT CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAM
Authorized Official - Middle Name:SHLOMO
Authorized Official - Last Name:RESHEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-524-1226
Mailing Address - Street 1:8919 KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1956
Mailing Address - Country:US
Mailing Address - Phone:847-972-1096
Mailing Address - Fax:
Practice Address - Street 1:830 W DIVERSEY PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-248-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.059003282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital