Basic Information
| Provider Information | |||||||||
| NPI: | 1326345844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF ILINOIS AT CHICAGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8919 KEELER AVE | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479721096 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 W DIVERSEY PKWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732484150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2011 | ||||||||
| LastUpdateDate: | 02/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | RESHEF | ||||||||
| AuthorizedOfficialFirstName: | NOAM | ||||||||
| AuthorizedOfficialMiddleName: | SHLOMO | ||||||||
| AuthorizedOfficialTitleorPosition: | FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 7735241226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 125.059003 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.