Provider Demographics
NPI:1649522095
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:SPECIAIST IN PT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:312-355-9600
Mailing Address - Street 1:34 MARENGO AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1107
Mailing Address - Country:US
Mailing Address - Phone:708-488-9045
Mailing Address - Fax:
Practice Address - Street 1:1919 WEST TAYLOR - 650 AHSB
Practice Address - Street 2:DEPARTMENT OF KINESIOLOGY AN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:708-507-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010259282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital