Provider Demographics
NPI:1720376965
Name:UNIVERSITY OF ILLINOIS CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF COLORECTAL SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:LEELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACS,MC,ABCRS
Authorized Official - Phone:312-413-2708
Mailing Address - Street 1:1740 WEST TAYLOR STREET,
Mailing Address - Street 2:UNIVERSITY OF ILLINOIS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:866-600-2273
Mailing Address - Fax:
Practice Address - Street 1:1740 WEST TAYLOR STREET,
Practice Address - Street 2:UNIVERSITY OF ILLINOIS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059358390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty