Provider Demographics
NPI:1336599463
Name:UNIVERSITY OF ILLINOIS DEPARTMENT OF PEDIATRICS
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS DEPARTMENT OF PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA-RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLONA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:312-355-0732
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:12TH FLOOR MC 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-0732
Mailing Address - Fax:312-355-0739
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:STE. 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-355-0732
Practice Address - Fax:312-355-0739
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics