University of Illinois

NPI #1255301909 in Peoria, Illinois

Provider Information

NPI Number: 1255301909
Entity Type: Organization
Organization Name: University of Illinois
Primary Specialty: Internal Medicine
Enumeration Date: Jan 25, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 530 NE GLEN OAK AVE
Address 2: DEPT OF INTERNAL MEDICINE
City: Peoria
State: Illinois
ZIP Code: 61637-0001
Phone: (309) 655-3292

Authorized Official

Name: WILLIAM R NICHOLAS, PHD
Title: EX DIRECTOR OF MEDICAL SERVICE PLAN
Phone: (312) 413-0573

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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