Basic Information
| Provider Information | |||||||||
| NPI: | 1164894465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF ILLINOIS AT CHICAGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 S WOLCOTT AVE | ||||||||
| Address2: | E 270 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129967161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 835 S WOLCOTT AVE | ||||||||
| Address2: | E 270 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129967161 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2015 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAYEKAR | ||||||||
| AuthorizedOfficialFirstName: | EMILY | ||||||||
| AuthorizedOfficialMiddleName: | MEREDITH | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8472875711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 125059887 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.