Provider Demographics
NPI:1659431351
Name:UNIVERSITY OF ILLINOIS
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-793-2350
Mailing Address - Street 1:2815 W WASHINGTON
Mailing Address - Street 2:P O BOX 19481
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9481
Mailing Address - Country:US
Mailing Address - Phone:217-793-2350
Mailing Address - Fax:217-793-0773
Practice Address - Street 1:2815 W WASHINGTON
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62794-9481
Practice Address - Country:US
Practice Address - Phone:217-793-2350
Practice Address - Fax:217-793-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare