Provider Demographics
NPI:1497008700
Name:UNIVERSITY OF ILLINOIS AT CHICAGO MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS AT CHICAGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RINGQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-996-3700
Mailing Address - Street 1:1801 W TAYLOR ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4795
Mailing Address - Country:US
Mailing Address - Phone:312-355-4394
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-355-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009832261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy