Provider Demographics
NPI:1801920186
Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Entity type:Organization
Organization Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAILAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-413-1350
Mailing Address - Street 1:1640 W. ROOSEVELT RD MC 727
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6904
Mailing Address - Country:US
Mailing Address - Phone:312-413-1871
Mailing Address - Fax:312-413-1593
Practice Address - Street 1:1640 W. ROOSEVELT RD MC 727
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6904
Practice Address - Country:US
Practice Address - Phone:312-413-1871
Practice Address - Fax:312-413-1593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL965680Medicare PIN