Provider Demographics
NPI:1871665950
Name:UNIVERSITY OF ILLINOIS CHICAGO PHYSICIAN GROUP (UICPG)
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS CHICAGO PHYSICIAN GROUP (UICPG)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, UICPG
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GALANTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-413-3037
Mailing Address - Street 1:914 S WOOD ST
Mailing Address - Street 2:MC 974, SUITE 229
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7337
Mailing Address - Country:US
Mailing Address - Phone:312-355-4271
Mailing Address - Fax:312-413-0254
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4319
Practice Address - Country:US
Practice Address - Phone:312-413-3037
Practice Address - Fax:312-413-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty