University of Illinois

NPI #1174596225 in Peoria, Illinois

Provider Information

NPI Number
1174596225
Entity Type
Organization
Organization Name
University of Illinois
Primary Specialty
Pediatrics - Neurodevelopmental Disabilities
Enumeration Date
Feb 9, 2006
Last Updated
Aug 22, 2020

Practice Location

Address
515 NE GLEN OAK AVE
Address 2
PEDIATRIC NEUROLOGY
City
Peoria
ZIP Code
61603-3165
Phone
(309) 624-9844

Authorized Official

Name
WILLIAM R NICHOLAS, PHD
Title
EXECUTIVE DIRECTOR OF MSP
Phone
(312) 413-0573

Specialties & Taxonomy Codes

Specialty
Pediatrics - Neurodevelopmental DisabilitiesNeurodevelopmental Disabilities

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