Provider Demographics
NPI:1891975512
Name:UNIVERSAL HEALTH, LTD
Entity Type:Organization
Organization Name:UNIVERSAL HEALTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAVASHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-271-1500
Mailing Address - Street 1:994 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3748
Mailing Address - Country:US
Mailing Address - Phone:773-271-1500
Mailing Address - Fax:773-271-2048
Practice Address - Street 1:1007 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5017
Practice Address - Country:US
Practice Address - Phone:773-271-1500
Practice Address - Fax:773-271-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101294Medicaid
IL01626490OtherBCBS
IL036101294OtherLISENCE
ILH22536Medicare UPIN
IL207489Medicare PIN