Provider Demographics
NPI:1851606339
Name:UNIVERSITY OF ILLINOIS AT CHICAGO
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS AT CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUILHERME
Authorized Official - Middle Name:
Authorized Official - Last Name:GIUSTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-884-9439
Mailing Address - Street 1:1440 SHERIDAN RD UNIT 405
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1856
Mailing Address - Country:US
Mailing Address - Phone:847-728-0893
Mailing Address - Fax:
Practice Address - Street 1:835 S WOLCOTT AVE # MC844
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-996-9858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058950251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare