Provider Demographics
NPI:1407012784
Name:UNIVERSITY OF IL OF CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF IL OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOON
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-733-3556
Mailing Address - Street 1:722 W MAXWELL ST STE 235
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:722 W MAXWELL ST STE 235
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5002
Practice Address - Country:US
Practice Address - Phone:312-996-2901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051746282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital