Board of Trustees of the University of Illinois

NPI #1003218348 in Rockford, Illinois

Provider Information

NPI Number: 1003218348
Entity Type: Organization
Organization Name: Board of Trustees of the University of Illinois
Primary Specialty: Family Medicine
Enumeration Date: Sep 18, 2014
Last Updated: Apr 27, 2016

Practice Location

Address: 1601 PARKVIEW AVE
City: Rockford
State: Illinois
ZIP Code: 61107-1822
Phone: (815) 395-5637

Authorized Official

Name: MRS. UMA SRIRAM
Title: DIRECTOR OF FISCAL AFFAIRS
Phone: (815) 395-5637

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Social Worker - Clinical — Clinical	1041C0700X
Marriage & Family Therapist	106H00000X
Family Medicine	207Q00000X	Primary

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