Provider Demographics
NPI:1265737670
Name:WOODS, UNICE LEE
Entity type:Individual
Prefix:
First Name:UNICE
Middle Name:LEE
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E CERMAK RD
Mailing Address - Street 2:A1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2123
Mailing Address - Country:US
Mailing Address - Phone:312-794-5193
Mailing Address - Fax:312-794-5286
Practice Address - Street 1:80 E CERMAK RD
Practice Address - Street 2:A1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2123
Practice Address - Country:US
Practice Address - Phone:312-794-5193
Practice Address - Fax:312-794-5286
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141939646OtherTAX IDENIFICATION NUMBER